Establishing A Heart Failure Clinic And Associated Registry For Underserved Populations

Introduction The prevalence of heart failure (HF) is projected to be greater than 8 million by 2030. Disparities in healthcare access and inadequate follow up in underserved populations lead to higher HF related readmission rates and cardiovascular mortality. In the population served by our safety net hospital, 10.4% are underinsured compared to the national uninsured rate of 8.6%. The patient to primary care provider ratio is 1300:1. Finally, heart disease contributes to the highest mortality rates, as well as is the leading cause of hospitalizations in our patient population. To reduce HF related morbidity and mortality, we establish a HF clinic and an associated registry. Hypothesis A dedicated HF clinic will optimize goal directed medical therapy and reduce 30-day readmission rates due to HF exacerbations. Methods A heart failure clinic was established at our safety net hospital. We followed the first 97 patients seen in the clinic for 30-days to record re-admission rates and study baseline characteristics. Data was collected sequentially by manual chart review of the electronic health records and analyzed using SAS version 9.4 (SAS Institute, Cary, NC). Results The mean (SD) age in the population was 60 (10) years. Of them, 40.2% were women, 36.1% were white, 57.7% were black, and 4.1% were Hispanic. Further, 41.2% had Medicare 39.2% had Medicaid, 11.3% had commercial insurance, and 8.3% were self-pay. Hypertension was prevalent in 73.2% of the population followed by non-ischemic cardiomyopathy in 58.8%, and type 2 diabetes mellitus in 32%. Majority, 82.5% had heart failure with reduced ejection fraction. The mean (SD) left ventricular ejection fraction was 30.7% (13.2). Patient characteristics are described in Table 1. In patients with HF with reduced ejection fraction, goal directed medical therapy (GDMT) with four agents was present in 18.2% patients, three agents in 27.3%, and two agents in 37.5%, Figure 1. Further, no statistically significant differences were observed for being on GDMT by age, gender, race, or insurance status. None of the patients were readmitted to the hospital on follow-up at 30-days. Conclusions We demonstrate that it is feasible to set up a HF clinic at a safety-net hospital serving underserved populations that has the potential to reduce re-admission rates. Long-term registry data can demonstrate sustained benefits and highlight further opportunities for improvement. The prevalence of heart failure (HF) is projected to be greater than 8 million by 2030. Disparities in healthcare access and inadequate follow up in underserved populations lead to higher HF related readmission rates and cardiovascular mortality. In the population served by our safety net hospital, 10.4% are underinsured compared to the national uninsured rate of 8.6%. The patient to primary care provider ratio is 1300:1. Finally, heart disease contributes to the highest mortality rates, as well as is the leading cause of hospitalizations in our patient population. To reduce HF related morbidity and mortality, we establish a HF clinic and an associated registry. A dedicated HF clinic will optimize goal directed medical therapy and reduce 30-day readmission rates due to HF exacerbations. A heart failure clinic was established at our safety net hospital. We followed the first 97 patients seen in the clinic for 30-days to record re-admission rates and study baseline characteristics. Data was collected sequentially by manual chart review of the electronic health records and analyzed using SAS version 9.4 (SAS Institute, Cary, NC). The mean (SD) age in the population was 60 (10) years. Of them, 40.2% were women, 36.1% were white, 57.7% were black, and 4.1% were Hispanic. Further, 41.2% had Medicare 39.2% had Medicaid, 11.3% had commercial insurance, and 8.3% were self-pay. Hypertension was prevalent in 73.2% of the population followed by non-ischemic cardiomyopathy in 58.8%, and type 2 diabetes mellitus in 32%. Majority, 82.5% had heart failure with reduced ejection fraction. The mean (SD) left ventricular ejection fraction was 30.7% (13.2). Patient characteristics are described in Table 1. In patients with HF with reduced ejection fraction, goal directed medical therapy (GDMT) with four agents was present in 18.2% patients, three agents in 27.3%, and two agents in 37.5%, Figure 1. Further, no statistically significant differences were observed for being on GDMT by age, gender, race, or insurance status. None of the patients were readmitted to the hospital on follow-up at 30-days. We demonstrate that it is feasible to set up a HF clinic at a safety-net hospital serving underserved populations that has the potential to reduce re-admission rates. Long-term registry data can demonstrate sustained benefits and highlight further opportunities for improvement.