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Summer 2008

Full Spectrum of Care for Heart Failure

The mission of the UCSF Heart Failure Evaluation and Treatment Program is to work cooperatively with referring physicians to provide the patient with treatments that relieve symptoms, slow disease progression, prolong survival and improve quality of life. The program offers the full spectrum of care for patients with heart failure.

"Our team works in close collaboration with the referring cardiologist or primary care provider at each step of the care continuum," says Teresa De Marco, M.D., medical director of the program. After evaluating the patient, shared patient management guidelines are developed and the care plan is communicated to the referring physician.

Patients may be referred at different points along this continuum. All patients benefit from individualized medical evaluation and treatment plans. The same physicians and other caregivers who see patients hospitalized for surgery will often see them as clinic outpatients.

The team comprises heart failure specialists, electrophysiologists, cardiothoracic surgeons and infectious disease specialists, as well as a comprehensive support staff.

"Once the referring physician contacts our team, we will schedule the patient to see us in our outpatient clinic within two to three weeks of the original referral," De Marco says.

"We are in constant communication with the referring physician to ensure that the agreed-upon treatment plan can be implemented in a timely fashion."

Through the same interdisciplinary team of UCSF specialists, patients whose disease is accompanied by arrhythmia — often a consequence of, or contributor to, heart failure—may benefit from additional medical treatment, device implantation or surgery.

In later stages of heart failure, devices such as ventricular assist devices or other forms of mechanical circulatory support may improve quality of life in appropriate patients.

Through clinical trials, program members also study new, experimental treatments and devices and offer therapies not available at other local centers.

Many patients are referred to the program to be evaluated for heart transplantation. Recent national data compiled by the Scientific Registry of Transplant Recipients found the one-year survival rate for heart transplantation at UCSF was 100 percent, compared with an expected survival rate of 87 percent. The three-year survival rate was 89 percent, compared with an expected rate of 81 percent.

As an example of working collaboratively to make patients' lives better, De Marco relates a typical story about what happened after a Northern California cardiologist referred a patient for heart transplant evaluation.

The heart transplant coordinator scheduled the appointment. As the patient lives quite a distance from UCSF, it was possible to schedule him to see all the key members of the team on the same day. The referring physician was called and a letter was sent to the patient. The plan for patient care was formulated in conjunction with the referring physician, taking into consideration the issues surrounding travel.

The patient required further testing, including cardiac catheterization. Based on the discussion with the referring physician, it was decided to perform the testing locally, utilizing a protocol developed at UCSF to determine specific hemodynamics. The protocol was faxed to the referring physician. Depending on the results of the local testing, plans were made for further treatment.

To contact the Heart Failure Evaluation and Treatment Program, call (415) 353-2873.

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