Heart Failure Care Management (HFCM) Program


The HFCM provider team consists of a pharmacist care manager and a nurse practitioner care manager. Both care managers have extensive experience in chronic disease management with a focus on optimizing HF guideline directed medical therapy (GDMT). Both stay up to date with constantly evolving clinical guidelines by attending educational programs such as Continuing Education (CE), and through precepting of pharmacy residents and interns. They stay up to date with medical literature involving novel therapies, such as angiotensin receptor-neprilysin inhibitors (ARNIs), as well as emerging ones, such as sodium-glucose cotransporter 2 (SGLT2) inhibitors. Our providers are also experts in considering each patient’s perspective, tailoring an individualized regimen utilizing shared decision making.

Because HF patients often have other chronic conditions, which often play a role in how the HF condition is managed, the HFCM team enjoys close interaction with other providers specializing in areas such as endocrine and diabetes, nephrology, oncology, pulmonology, as well as the Homeless Program and Custody Health. Communication across different disciplines ensures that an effective team-based approach is in place to improve clinical outcomes while considering the diagnosis and treatment of all relevant conditions the patient may have.

Another example of our wide range of treatment approaches is with our Cardiac Device program. Many HF patients may already have implanted devices, or will be candidates for device therapy, so each patient is reviewed for candidacy at each clinic visit in accordance with clinical guidelines. For patients eligible, they undergo a rigorous evaluation in conjunction with General Cardiology to determine if this is the optimal treatment approach. For patients with device therapy in place, our providers are given additional data points for patient-centered medication titration.