Providing financial support early after hospital discharge to economically vulnerable patients with heart failure (HF) with reduced ejection fraction is feasible and significantly improved adherence to prescribed medications, according to results from the FUND-HF pilot trial presented during an Investigative Horizons session at ACC.26 in New Orleans and simultaneously published in JACC.

In the trial, patients were provided with a single payment of $500 on a ClinCard without any spending restrictions. Eligible patients had an income of less than 130% of the Federal Poverty Level, challenges in paying monthly bills and at least one additional adverse social driver of health (SDOH). They were recruited within two weeks of hospitalization for HF at Parkland Memorial Hospital in Dallas, TX.

The key objectives of the trial were to assess the feasibility of delivering financial support during the post-discharge transition period, to identify which outcomes were most likely to be affected and to generate preliminary treatment effect estimates to use in a larger trial.

Conducted from 2023 to 2025, the trial randomized 153 adult patients 1:1 to an early financial support group or usual care without financial support (control group). The mean age was 53 years, 76% were men, 73% self-reported as Black and 54% were uninsured. Patients in the early financial support group had a median monthly income of $840 vs. $400 for those in the control group.

At the one-month follow-up, the key outcome of tested medication adherence was higher in the financial support group vs. the control group (mean adherence 0.74 vs. 0.54; p=0.001). When compared with the control group, the financial support group had a 42% higher probability of complete adherence relative to nonadherence as well as significantly greater adherence to test HF guideline-directed medical therapy (metoprolol, spironolactone).

The mean baseline-adjusted Kansas City Cardiomyopathy Questionnaire Overall Summary Score (57.5 vs. 56.9) and all-cause hospitalization rates (rate ratio, 0.66) did not differ between the groups.

“These findings will inform future larger trials with longer-duration interventions and extended follow-up to evaluate the durability of adherence benefits and effects on [health-related quality of life] and clinical endpoints,” write Neil Keshvani, MD, et al.

In an article simultaneously published in JACC: Advances detailing the study design, methods and baseline characteristics, Syed K. Rizvi, MD, et al., write that their “upstream approach” to supporting patients in need “represents a shift from health care system interventions toward direct adverse SDOH modification during critical clinical transitions.”

Keywords: ACC Annual Scientific Session, ACC26, New Orleans, Financial Support, Medication Adherence