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Re-Inventing the HF Program at Tucson VA

Re-Inventing the HF Program at Tucson VA. Elizabeth Juneman, MD & Elaine Charteris, NP Heart Failure Program Southern Arizona VA Health Care System University of Arizona, Tucson. Background. Southern Arizona VA Health Care System

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Re-Inventing the HF Program at Tucson VA

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  1. Re-Inventing the HF Program at Tucson VA Elizabeth Juneman, MD & Elaine Charteris, NP Heart Failure Program Southern Arizona VA Health Care System University of Arizona, Tucson

  2. Background • Southern Arizona VA Health Care System • Referral area for all Arizona, part of New Mexico & western Texas • University of Arizona & Sarver Heart Center • Dr. Steven Goldman • Prior SAVAHCS HF program • Part-time near-retired cardiologist • Part-time HF NP

  3. Background • HF Performance Measures • New academic cardiologist • Basic science research in HF • New dedicated HF NP RE-INVENT HF PROGRAM

  4. Background • Consistently w/in 95% benchmark for EPRP for HF • Despite that, SAVAHCS HF Program: • Lack of focus • 30-day post-hospitalization follow-up • Transplant patients • Device referral and follow-up

  5. Goals • Focus on AHA HF Stage C • Transplant care coordination • Conjunction with U of A • Device management • Enrollment in clinical trials

  6. Outline • Outpatient clinics • Inpatient care • Device / remote monitoring • Transplant • Clinical trials • Outstanding Issues

  7. Documentation First ! • New HF Templates • Medications by class & titration scale • Revascularization / viability • ICD / Remote monitoring • CHF study enrollment potential • Vaccines / smoking / weight / afib • Document education done • Information for referring MD Can be sent to you if requested …

  8. Outpatient Clinics • All consults for HF screened by NP • Post-hospitalization f/u captured by NP • 4 half-day clinics (MD & NP) • 1 urgent slot each clinic • Active or decompensated HF patients • Stable … returned to PCP or general cardiology clinic

  9. Outpatient Clinics • Patient education • Individually & with hand-outs • Group clinics … TBA • 8-10 patients • 30 minutes • Cardiology Fellow • Social service required for fellowship

  10. Staff Cardiologist HF fellow HF NP Pacemaker RN Sonographer Pharmacist +/- Electrophysiologist 1 half day clinic / wk “Round-Robin” Device check Echo guided AV Opt Med reconciliation Fluid assessment Education materials Multi-Disciplinary HF Clinic START DATE SEPT 2008 … 1st in Tucson

  11. Inpatient Care • Cardiology Fellow on CCU • Occasional dedicated HF fellow • Transitional end-stage devices not available at our VA • LVAD, RVAD, artificial hearts … U of A • Discharge RN protocol • Not under cardiology jurisdiction • Area of potential growth if more FTE

  12. Devices & Remote Monitoring • Area of interest • New electrophysiologist • Approx ~150 patients with active devices with potential for remote monitoring • Cooperation & coordination with industry • Data management … BIG ISSUE

  13. Devices & Remote Monitoring • Pacer RN & HF NP • Goal to follow-remote data 1 day per week • VT episodes • ATP, tachyarrhythmias • Fluid management, HRV, activity • % Bi-V pacing • Multi-disciplinary HF Clinic

  14. Transplant • ~30 patients • ~20 patients followed University of Arizona Cardiac Transplant Team • 6 coordinators • Re-establish working relationship • Annual work-ups & biopsies • Immunosuppression

  15. Clinical Trials • At any time, 5-10 active enrolling HF trials • VA sponsored & industry • Ask all HF patients if they are interested  forward to research coordinator • Prompt in HF template • Research coordinator rounds with CCU team daily & in fellows clinic • Increased study enrollment

  16. Definition of Success • Benchmarks • 30-day re-admission rate • Measurement of LVEF … we do this well • Post-hospitalization follow-up • High risk in 48 hrs • Personal • Remote monitoring • Multi-disciplinary HF Clinic

  17. Outstanding Issues • Dedicated pharmacist • Separate careline TELEHEALTH • No integration with cardiology • Some patients live in Mexico • No ability for remote monitoring • HF Admission Orders • Work-load capture of remote monitoring

  18. Leadership & Staff • VA Chief of Cardiology, Dr. Steven Goldman • HF & Imaging, Dr. Elizabeth Juneman • EP, Dr. Sergio Thal • Interventional, Dr. Hoang Thai • Transplant / Interventional, Dr. Reza Movahed • HF NP, Elaine Charteris • EP NP, Mary K Pierce • Pacer RN, Lori Pack

  19. Questions? • elizabeth.juneman@va.gov • elaine.charteris@va.gov

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