"RESUME-HFC"-EXPLORING AN ALTERNATIVE MODEL OF HEART FAILURE CARE FOR PATIENTS WITH SUBSTANCE USE DISORDER AND/OR MENTAL HEALTH NEEDS

“RESUME-HFC” – Exploring an alternative model of heart failure care for patients with substance use disorder and/or mental health needs. Heart failure (HF) care often requires multidisciplinary care, including intensive patient education, testing and follow-up. Literature shows that patients with substance use disorder (SUD) and/or mental health needs have difficulty adhering to the requirements of a regimented care model and recommends an individualized, flexible follow-up schedule. Our experience has shown that these patients often attended HFC haphazardly, if at all. We proposed an alternative model of heart failure care whereby these patients were seen by a HF specialist Nurse Practitioner (NP) who assessed the patient's ability to manage medications, appointments and learning needs on an individual basis, and tailored a care plan around these potential barriers. For patients that had had previous referrals but did not attend appointments, the NP would go to the emergency department or inpatient unit to meet patient and discuss the referral to our clinic, in hopes of approving attendance. Key elements in the care plan included utilizing community support workers to bring patients to appointments, connecting with community pharmacy for daily medication management, connecting with primary care provider/clinic to discuss plan and requesting outreach if indicated. We conducted a pilot study to explore the feasibility of providing this alternative model of outpatient care for patients with HF and SUD and/or mental health needs who are unlikely or unable to attend the HFC. We also sought to determine if outcomes are impacted by this alternative model.

Using a pre-test/post-test design with patients as their historical controls we collected data on ED visits, hospitalizations, quality of life, ejection fraction and mortality for 1 year pre- and 1 year post-index visit. 23 of 26 patients completed the study (lost to follow-up = 1; death = 1 (unknown cause); moved = 1). There was a statistically significant reduction in total hospitalizations (2.8 vs 1.4, p = 0.017), length of stay (11.5 vs 0, p = 0.009), increase in quality of life (4.27 vs 6.73, p = 0.04 and a clinically significant increase in ejection fraction (33% vs 45%, p NS).

This NP-led model of care that provided individually tailored, flexible management of HF in those with SUD and/or mental health needs can be feasible, if appropriately resourced. This model of care shows promise for HF management in this complex patient population.