Addressing a National Health Crisis: A Student-Run Congestive Heart Failure Clinic for Underserved Patients.

Abstract

To the Editor: Heart failure is the leading cause of hospitalization among the elderly, with an estimated yearly cost of ~$108 billion dollars globally, of which ~$30 billion is spent in the United States. 1 Much of this burden is due to heart failure’s high national readmission rates—the 30-day readmission rate is 24% and the 1-year readmission rate is 60%. 2 Furthermore, meta-analyses of heart failure readmission rates show that socioeconomic factors, including lack of occupation and difficulties receiving care from qualified health professionals, often play a greater role than medical factors like hypertension. For example, lack of occupation (odds ratio = 2.6, 95% confidence interval: 1.2, 5.5) was a stronger predictor of poor heart failure outcomes than hypertension (odds ratio = 2.0, 95% confidence interval: 1.1, 3.7). 3 For those without many resources, a heart failure diagnosis can mean endless emergency readmissions, slowly deteriorating health, and a financial burden that can place struggling families into poverty. 4 This may further engender distrust of the medical community, result in decreases in compliance, and ultimately may perpetuate the cycle of readmission. To combat this, interprofessional students at the University of Texas Medical Branch at Galveston established the Congestive Heart Failure Comprehensive Care Clinic for heart failure patients who cannot afford outpatient therapy. This clinic operates within the St. Vincent’s Student-Run Free Clinic, one of the largest of its kind in the United States. The Congestive Heart Failure Comprehensive Care Clinic seeks to reduce 30-day readmissions and improve quality of life through a 60-day program incorporating exercise, nutrition counseling, smoking cessation, cognitive behavioral therapy, medical evaluations, and more. Partnerships with social workers and community health workers also ensure our patients have transportation, safe housing, and a stable food supply. All patients receive standard-of-care medical therapy (including medications) for free. At the time of this writing, only 6 of 50 patients enrolled in the program have been rehospitalized, while the expected number, given the uninsured setting, was 12–15. We want to leave you with something a patient told us that we feel summarizes the goal of our clinic: “When I first got my heart failure diagnosis, I thought it meant my life was over. This program helped me see that it’s not.” Acknowledgments: The authors thank all of the members of the heart failure team at St. Vincent’s Student-Run Free Clinic for their dedication to the clinic and the patients the clinic serves. The authors would also like to thank the University of Texas Medical Branch at Galveston President’s Cabinet and the Sealy & Smith Foundation for funding this endeavor.