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NCT07730827Recruiting

Community-Informed Interventions for Equitable Congestive Heart Failure Management in Primary Care

Mayo Clinic

Start Date

7/6/2026

Completion Date

7/1/2029

Summary

The purpose of this study is to expand subject matter expertise and sustained capacity for equity-oriented care within the Advanced Care Ecosystem (ACE) by engaging patients, caregivers, community health workers (CHW), and care-team stakeholders in development work focused on adults living with congestive heart failure (CHF) and adverse social determinants of health (SDoH).

Eligibility Criteria

Age Range: 18 years to No maximum

Inclusion Criteria: Patients living with congestive heart failure (CHF): * Age 18 years or older. * Diagnosis or clinical documentation of CHF or heart failure in the Mayo Clinic medical record. * Empaneled in Mayo Clinic, Rochester, primary care * Evidence in the EHR of one or more adverse SDoH, elevated utilization, medical/social complexity. * Able to provide informed consent. * Able to participate in study procedures. Caregivers: * Age 18 years or older. * Caregiver with relevant lived, caregiving, or community experience related to CHF, and nominated by the patient. * Able to provide informed consent * Able to participate in study procedures. Community health worker and care-team stakeholders: * Age 18 years or older. * Current or recent role relevant to CHF care, transitions of care, SDoH, patient education, or CHW workflows. * Able to provide informed consent * Able to participate in study procedures. Exclusion Criteria: * Under age 18 years. * Unable or unwilling to provide informed consent.

Interventions

OTHER

Interviews and group discussion for patients and caregivers

OTHER

Interviews and group discussion for community health worker and care-team stakeholders

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Conditions

Congestive Heart FailureHeart Failure

Locations

Mayo Clinic

Rochester, Minnesota 55905

United States