The St. Vincent’s Congestive Heart Failure Comprehensive Care Clinic: A Community-Based Intervention and Analysis

Abstract

IntroductionHeart Failure disease management clinics have been historically successful in reducing complications, little has been examined in uninsured settings.MethodsThis is a pilot study of HF patients following a recent hospitalization. Uninsured patients were offered enrollment in the disease management clinic during or immediately following hospitalization for a primary HF diagnosis at our institution during 2021. The program included twice-weekly visits with interprofessional support. Patients were scheduled 16 visits (2 months of follow-up) post-hospitalization. Patients who attended two visits were considered enrolled.ResultsOf 59 patients referred, 47(80%) were enrolled. Just 4 patients (8.5%,95%CI:2.5%,20.5%) were readmitted at 30 days, while 4 of 12 (33%,95%CI:13.6%,61.2%) were readmitted at 30 days in those who did not enroll. Program participants were readmitted significantly less frequently than national readmission rate estimates (23%,p=0.02).ConclusionThe CHFC3 program is feasible and holds promise for materially reducing 30-day readmissions for HF complications in the uninsured.