Financial Support After Hospital Discharge Boosts HFrEF Outcomes: FUND-HF

NEW ORLEANS, LA—A pilot program that provided financial aid to low-income patients with heart failure with reduced ejection fraction (HFrEF) after a hospitalization resulted in better medication adherence at 1 month when compared with controls, according to the FUND-HF trial.

Patients randomized to financial help received $500, with no restrictions on how it was to be spent, while those in the control group were compensated similarly at the end of the study period. Rates of complete adherence to all medications as determined by therapeutic drug monitoring were 58.7% in the early compensation group and 42.3% in controls (P = 0.015), said Ambarish Pandey, MD (University of Texas Southwestern Medical Center, Dallas), in a presentation here last week at the American College of Cardiology 2026 Scientific Session. The study was simultaneously published in JACC.

“While the risk of all-cause hospitalization was numerically lower in the financial support arm, the intervention had no unintended safety consequences, with significantly lower rates of positive drug screen in the financial support arm, and no worsening in psychological distress in either group,” Pandey noted.

Although the study groups were small, the findings can be viewed as a proof of concept for early financial support as a meaningful strategy to improve HF care in this vulnerable population, he said. Additionally, Pandey said they lay the groundwork for a “definitive multicenter trial that should evaluate adherence, durability, and clinical outcomes over longer term.”

Early Financial Support Strategy

The FUND-HF investigators enrolled 153 HFrEF patients (mean age 53 years; 73% Black) at a large, urban, safety-net hospital, randomizing them within 14 days of discharge for an acute HF event to receive $500 immediately on a debit card or $500 at 30 days. Prior to the stipend, the median monthly income was $600, with about half of participants reporting housing instability. Roughly 75% of patients reported non-adherence to prescribed medications because of cost, 85% reported food insecurity, and 65% reported transportation barriers related to healthcare.

The financial compensation could be used for purchases with debit-card functionality or to withdraw cash. While no guidance was given to patients on how to use the funds, they were told that the money was intended to support their post-discharge recovery. For the average participant, $500 represented 83% of their median monthly income.

In a regression model, the early financial support arm had a 42% higher probability of complete adherence than the control group (P = 0.015) at 1 month. Similarly, the financial arm had greater adherence to guideline-directed medical therapy consisting of metoprolol and spironolactone (71% vs 47% in the control arm; P = 0.019).

Quality of life (QOL), as measured by the Kansas City Cardiomyopathy Questionnaire overall summary score, improved by approximately 16 points in both groups (P = 0.86). Rates of all-cause hospitalization were 24.3 events per 100 person-years in the financial support group and 36.6 in the control group (P = 0.17) and HF hospitalization rates were 21.8 and 30.5 per 100 person-years, respectively (P = 0.29).

Substance use on urine analysis was lower overall in the financial support group compared with controls (24.1% vs. 45.0%; P = 0.029).

Disruptive, But With Caveats

Clyde Yancy, MD (Northwestern Feinberg School of Medicine, Chicago, IL), who chaired the session, described the study design as “brilliant,” adding that it can be difficult to fully grasp the challenges that patients like these face as they navigate HF with low income and a host of other adverse social determinants of health.

Likewise, panelist Thomas Maddox, MD, MSc (Washington University School of Medicine, Saint Louis, MO), called the intervention “disruptive.”

“But I almost wonder, did we go too far? Yes, we had improved adherence. They also knew they were going to get a blood draw in 30 days, and they knew they were going to be checked for [medication] adherence,” Maddox noted. “So, I wonder if they [knew] they were going to be tested and responding accordingly.”

With no statistically significant differences between groups in all-cause mortality or quality of life, albeit in an underpowered trial, Maddox said there may be value in trying to understand how vulnerable patients with so many unaddressed needs end up spending the money they are given in these types of interventions.

Pandey said the investigators were able to track spending through the debit card. While there were no between-group differences in the purchasing of medications or healthcare because those were covered through the trial site, there was a substantial difference in the amount of money spent on daily life activities, including buying food and paying for essential utilities. Retail and shopping accounted for the most spending at 30.9%, followed by food and beverage.

For Pandey, that finding highlights “that these patients have much more dire needs that are upstream of medication access, which actually drive a lot of their healthcare behavior.” The intervention, he added, may have reduced some of the financial stress and burden, which in turn allowed patients to do a better job of taking care of their health.

Panelist Minang Turakhia, MD (Stanford School of Medicine, CA), added that financial support also may create accountability. Going forward to an RCT, he wondered how it could be best designed to answer some of these questions.

Pandey said his group is looking at the potential for a 6-month trial with monthly financial aid to see “whether or not a sustained support can actually mitigate some of these social determinants of health challenges and improve outcomes.” However, one difficulty for a longer trial will be balancing things fairly so the control group doesn’t significantly worsen over time. The team is also discussing alternative approaches that might be more scalable for determining adherence such as electronic monitoring devices and patient-reported feedback.