Heart Failure and Pulmonary Hypertension
The University of California, San Francisco (UCSF) Advanced Heart Failure and Pulmonary Hypertension program is an internationally recognized program that offers the full spectrum of therapies for heart failure patients, such as lifestyle and dietary modifications, disease management, evidence-based pharmacotherapy, electrophysiological devices, mechanical circulatory support and heart transplantation.
Our multidisciplinary team of experts – including physicians, nurses, pharmacists, dietitians, physical therapists and social workers – works closely with referring physicians to relieve symptoms, slow disease progression, prolong survival and improve quality of life in patients with heart failure. The team evaluates and can assist in the management of patients with risk factors for heart failure, as well as patients with mild, moderate or advanced stage disease.
In addition to the approximately 5,000 heart failure patients across UCSF practices, our program evaluates several hundred new patients every year. State-of-the-art genetic testing, imaging modalities (3D echocardiography, cardiac magnetic resonance imaging, cardiac positron emission tomography, and coronary computed tomography), invasive/interventional procedures (right and left heart catheterization, myocardial biopsy, coronary angioplasty, valvuloplasty, and alcohol septal ablation) and cardiac surgeries (mitral valve repair, ventricular reconstruction, high-risk coronary artery bypass, ventricular assist device implantation, and heart transplantation) are all available at UCSF.
Treatment options can include both conventional and experimental therapies. Intensive case management using dedicated nurses and nurse practitioners, innovative teaching materials, and a comprehensive transition of care model helps patients and families adhere to medication regimens and make sustainable lifestyle changes. Our enhanced discharge program is characterized by tightly spaced follow-up visits and careful coordination with external physicians and caregivers. As a result, our readmission rates are among the lowest in the nation, making our program a model in California.
For patients 65 years of age and older, we can coordinate care with the specialized clinical practices from the Division of Geriatrics who are experienced in evaluating and addressing older adults’ needs. This ensures that older heart failure patients, who are at highest risk for readmission, receive a physician house call within 48 hours of discharge and a follow-up visit within seven days. Physicians and nurse practitioners work closely with each patient’s visiting nurse, primary care provider and caregivers to optimize the patient’s well-being and reduce the need for emergency room visits and hospitalizations.
For those patients with advanced heart failure (stage D), characterized by progressive symptoms and poor quality of life despite optimal pharmacological and electrical device therapies, we offer a full spectrum of therapies, including mechanical circulatory devices and heart, heart-kidney and heart-lung transplantation. With over twenty years of experience and more than 260 patients transplanted to date (including 10 heart-lung and 20 heart-kidney transplants), the UCSF Heart Transplant Program is one of the most experienced and successful in the region, with outstanding outcomes.
Multidisciplinary care and technical advances make our Mechanical Circulatory Support Program a viable option for an increasing numbers of patients as a short-term bridge to recovery, a longer-term bridge to transplant, or as destination therapy. UCSF is unique because we offer expertise in both mechanical circulatory support and extracorporeal life support, and have experience in using nearly all FDA-approved devices. Each year, 15-20 devices are implanted at UCSF. Our physicians are particularly skilled at recommending the right approach and device for each patient. We also carefully train patients and their families, and offer 24/7 clinical and technical support once they return home. Our follow-up program extends to training local fire departments, emergency medical services and emergency rooms.
The UCSF Pulmonary Hypertension Program was established over two decades ago, and is designated as a center of excellence for the evaluation and treatment of the disorder. Our program actively follows more than 250 patients, offering a full spectrum of care ranging from oral, inhalational and catheter-based therapies to experimental therapies and lung transplantation. A team of physicians, nurse practitioners, pharmacists and social workers – dedicated to education as well as approved, state-of-the-art pharmacologic and surgical management (including lung transplantation) – creates patient-centered, individualized management programs that optimize care and help patients better manage their condition.
Under the leadership of Teresa De Marco, MD, the Advanced Heart Failure and Pulmonary Hypertension Program at the University of California, San Francisco has some of the best outcomes in the nation.
We strive to provide high-quality health care to all of our patients. As such, data from The Joint Commission (the independent, not-for profit organization that accredits and certifies more than 19,000 health care organizations and programs in the U.S.) shows that nearly 100% of our hospitalized heart failure patients are counseled to stop smoking, are provided with comprehensive discharge instructions, have their left ventricular systolic function evaluated, and are being prescribed evidence-based heart failure therapies (ACE inhibitors or ARBs).
The national 30-day readmission rate for Medicare heart failure patients is very high, at 24.5%. In contrast, UCSF has one of the lowest rates in the nation, with an average for 30-day all cause heart failure readmissions of only 11%. In addition, our 90-day readmission rate is also one of the best in the nation at 26%. Over 450 individual patients are admitted annually at UCSF for acute decompensated heart failure; due to our expertise, the inpatient and 30-day post discharge mortality rates are also lower than the national average.
Each year, 15-20 transplants are performed at UCSF, with more than 260 patients transplanted to date (including 10 heart-lung and 20 heart-kidney transplants). Recent national data compiled by the Scientific Registry of Transplant Recipients found that the one-year survival rate for heart transplantation at UCSF was 97%, compared to a national survival rate of 89%.