The dangers of heart and lung failure are clear: If these conditions progress, the eventual result is organ transplantation or death. Recent data from the Scientific Registry of Transplant Recipients, which considers the severity of caseload, indicate that both heart and lung transplant patients at UCSF Medical Center fare better than expected. We believe this reflects a process of close coordination among referring physicians and the comprehensive medical services available at our facility.
Coordination is critical because heart failure and lung failure are often linked; physiological processes that result in the progressive failure of one organ may lead to failure of the other. For instance, pulmonary hypertension can present as heart failure. To determine that a patient has heart failure due to lung circulatory problems, a variety of specialists must complete intensive diagnostic work.
Designing and implementing treatment also involve multiple clinicians, and the medications often demand fine-tuning—making numerous adjustments over time. Slight medication changes can tip a patient in the wrong direction. Similarly, the diet and exercise regimens that are part of the treatment for heart and lung failure patients require that all clinicians be on the same page.
This level of coordination can be challenging for one physician in a single practice to handle. And while a community hospital may have all these resources, it may struggle to make them available to the patient in a short period of time. The only way to pull all of the necessary resources together in a concentrated period of time is to have an adequate number of patients. Thankfully, our referring physicians provide the caseload and demonstrate the value of a strong, working relationship among all physicians involved in the care of these complex patients.
Working as a team enables us to see each patient more often; during a single visit to UCSF Medical Center, patients can consult with a full range of specialists. In addition, colleagues who serve on multidisciplinary teams meet weekly to discuss the difficult cases that are the norm among those referred here. Many patients improve with this multidisciplinary medical approach and never require a transplant. When they do require transplantation—in some cases, of both organs—the data from the Scientific Registry of Transplant Recipients demonstrate that our surgeons have a strong success rate.
Michael Crawford, M.D.
Chief of Clinical Cardiology
UCSF Heart and Vascular Center
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