Advanced Heart Failure Comprehensive Care Center

 

The University of California, San Francisco (UCSF) Advanced Heart Failure Comprehensive Care Center is an internationally recognized program that offers the full spectrum of therapies including 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, advanced practice providers, pharmacists, dietitians, physical therapists, social workers, psychiatry, and palliative care service group – 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.

Available treatments at UCSF 

State-of-the-art genetic testing and imaging modalities

• 3D echocardiography
• cardiac magnetic resonance imaging
• cardiac positron emission tomography
• coronary computed tomography

Invasive/interventional procedures

• right and left heart catheterization
• coronary angioplasty
• valvuloplasty
• MitraClip
• sphlanic nerve denervation for heart failure with preserved ejection fraction
• alcohol septal ablation
• myocardial biopsy

Cardiac surgeries

• mitral valve repair
• ventricular reconstruction
• high-risk coronary artery bypass
• ventricular assist device implantation
• heart transplantation
• multi-organ transplantation

Treatment options can include both conventional and experimental therapies. For diuretic refractory acute heart failure, we can utilize ultrafiltration which has the ability to diurese more effectively with reduced renal compromise. Intensive case management and remote implantable monitoring devices such as CardioMems, as well as other novel pulmonary artery sensors currently under clinical trial in appropriate patients, incorporating 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. We utilize advanced artificial intelligence software that supports national guidelines for optimal pharmacologic treatment of heart failure ensuring that all of heart failure patients are regularly being screened for ongoing optimization of their heart failure medical regimen. Our enhanced discharge program is characterized by tightly spaced follow-up visits, generally within 7 days of discharge and careful coordination with external physicians and caregivers. As a result, we have been able to maintain our 30 day internal readmission rate under 16%. We have a multitude of several pivotal national clinical trials involving innovative device therapies to treat both heart failure with reduced ejection fraction (HfrEF) and heart failure with preserved ejection fraction (HfpEF) that has been refractory to conventional medical management.

Advanced Heart Failure (stage D)

Advanced heart failure (stage D) is characterized by progressive symptoms and poor quality of life despite optimal pharmacological and electrical device therapies, we offer a full spectrum of therapies, including a full complement of mechanical circulatory devices. These include acute support devices, Impella, ECMO, Tandem Heart as well as durable left ventricular assist device (LVAD), with a minimally invasive surgical approach, which improves physical rehabilitation and decreases length of stay. We offer the total artificial heart (TAH) for patients with biventricular end stage heart failure as a bridge to heart transplant. We have a growing heart transplant program offering heart transplant, as well as multi-organ transplantation heart-kidney, heart-lung, heart-liver transplantation.

Heart Transplant Program

With over 30 years of experience and a significant growth recently from an average of over 20-25 to 50 transplants per year. We utilize increased donor preservation technologies including the Paragonix SherpaPak Cardiac Transport System and the TransMedics Organ Care System (OCS) allowing UCSF to transport hearts from longer distances. The UCSF Heart Transplant Program is one of the most experienced and successful in the region, with observed results comparable to expected outcomes (Scientific Registry of Transplant Recipients). The heart transplant program is the recipient of the Press Ganey’s Voice of the Patient - Pinnacle Award for achieving outstanding patient satisfaction in 3 consecutive years.

The UCSF Advanced Heart Failure team is part of the UCSF Cardiogenic Shock team that offers lifesaving care for patients.  There is seamless coordination of patient transfers of critically ill hospitalized patients to UCSF to allow for the best chance of survival of their critical illness. 

UCSF is the largest volume centers for Mechanical Circulatory Support (MCS) in Northern California. Our multidisciplinary care and technical advances make our MCS 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, 30-40 durable 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 MCS Program was one of the first in the nation to utilize remote monitoring strategies incorporated into the electronic medical record to reduce readmission rates and ventricular assist device complications.