Heart Failure Clinic

ZSFG Heart Failure Clinic launched in 2007 when primary providers from San Francisco Health Network requested co-management for diuretic therapy and disease modifying agents such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), aldosterone inhibitors, and long-acting beta blockers for their patients with chronic heart failure. It was soon apparent that such individuals require additional measures to prevent disease progression and death.

Heart Failure Clinic coordinates echocardiograms, genetic tests, cardiac magnetic resonance imaging, cardiac positron emission tomography, and cardiac catheterization to identify causes of cardiomyopathy and measure clinical responses to medication management. The heart failure team also partners with primary care providers to encourage lifestyle and dietary modifications that improve exercise capacity and reduce symptoms. There is major emphasis on reducing exposure to cigarette smoke, stimulants, ethanol, and other substances that are toxic to cardiovascular tissue. ZSFG patients who require additional heart failure therapies can be referred to UCSF Medical Center for cardiothoracic surgery, advanced percutaneous interventions, electrophysiology studies, device implantation, and heart transplantation.

Zuckerberg San Francisco General Hospital has identified reduction of 30-day all-cause readmissions for patients with an index heart failure admissions as a high organizational priority for 2018-2019. Accordingly, ZSFG Heart Failure Clinic is staffed by 3 cardiology nurse practitioners and 2 cardiology physicians with expertise in acute heart failure and chronic disease management. The heart failure team recently began collaboration with physicians from the community-based palliative care program at ZSFG. Their work is supported by Senate Bill 1004, which requires that all Californians enrolled in managed Medi-Cal plans have access to palliative care. Workflows for palliative care clinic visits and telehealth appointments for heart failure patients and families are in development.