Introduction: Post-hospitalization heart failure (HF) disease management represents an important area of focus in preventing morbidity, mortality, and excess healthcare costs. Disease management clinics have been historically successful in reducing complications, but complication reduction in the uninsured setting has not been thoroughly examined. The purpose of this project is to conduct a post-hospitalization disease management clinic pilot study of uninsured HF patients.   Methods: This is a pilot study of HF patients following a recent hospitalization (within 30 days). Uninsured patients were offered enrollment in the disease management clinic during or immediately following hospitalization for a primary HF diagnosis at University of Texas Medical Branch at Galveston. The enrollment period was from January 2021 - December 2021. The disease management program included twice-weekly visits with a variety of healthcare professionals, including nurses, physicians, occupational therapists, social workers, pharmacists, and counselors. Patients were scheduled for a maximum of 16 visits (2 months of follow-up) post-hospitalization before returning to usual care. Patients who attended at least the introductory appointment and one follow-up appointment within 30 days of discharge were considered enrolled. The primary outcome is 30-day readmission, while secondary outcomes included feasibility measures (proportion enrolled, number of visits attended).  Results: Of 59 patients referred, 47 (80%) were enrolled. Just 4 patients (8.5%, 95% CI: 2.5%, 20.5%) were readmitted at 30 days, while 4 of 12 (33%, 95% CI: 13.6%, 61.2%) were readmitted at 30 days in those who did not enroll. Program participants were readmitted significantly less frequently than national readmission rate estimates (23%, p=0.02).   Conclusion: The CHFC3 program is feasible and holds promise for materially reducing 30-day readmissions for HF complications in the uninsured. A randomized controlled trial is warranted to further explore this intervention.

BACKGROUND: Preoperative localization is necessary for nonpalpable breast lesions. A novel procedure, fluoroscopic intraoperative neoplasm and node detection (FIND), obviates the preoperative painful and potentially expensive localization by using intraoperative visualization of the standard clip placed during diagnostic biopsy. We hypothesized FIND would improve negative margin rates. STUDY DESIGN: This is an IRB-approved retrospective study (September 2016 to March 2021). Electronic chart review identified breast and axillary node procedures using wire localization (WL) or FIND. Primary outcome was margin status. Secondary outcomes included re-excision rate, specimen weight, surgery time, and axillary node localization rate. RESULTS: We identified 459 patients, of whom 116 (25.3%) underwent FIND and 343 (74.7%) WL. Of these, 68.1% of FIND and 72.0% of WL procedures were for malignant lesions. Final margin positivity was 5.1% (4 of 79) for FIND and 16.6% (41 of 247) for WL (p = 0.008). This difference lost statistical significance on multivariable logistic regression (p = 0.652). Re-excision rates were 7.6% and 14.6% for FIND and WL (p = 0.125), with an equivalent mean specimen weight (p = 0.502), and mean surgery time of 177.5 ± 81.7 and 157.1 ± 66.8 minutes, respectively (mean ± SD; p = 0.022). FIND identified all (29 of 29) targeted axillary nodes, and WL identified only 80.1% (21 of 26) (p = 0.019). CONCLUSIONS: FIND has lower positive margin rates and a trend towards lower re-excision rates compared with WL, proving its value in localizing nonpalpable breast lesions. It also offers accurate localization of axillary nodes, valuable in the era of targeted axillary dissection. It is a method of visual localization, using a skill and equipment surgeons already have, and saves patients and medical systems an additional schedule-disruptive, painful procedure, especially valuable when using novel localization devices is cost-prohibitive.