What is the scope in managing heart failure?

Comprehensive Scope of Heart Failure Management

Heart failure management requires a multidisciplinary care approach that encompasses both hospital and community settings to reduce mortality, prevent hospitalization, and improve quality of life. 1

Organization of Care

• A "seamless" system of care is essential, integrating both community and hospital services throughout the patient's healthcare journey 1
• Multidisciplinary management programs are fundamental to delivering comprehensive care, improving outcomes through structured follow-up with patient education, medication optimization, psychosocial support, and improved healthcare access 1
• Patients with heart failure should be enrolled in a multidisciplinary care management program to reduce the risk of hospitalization and mortality (Class I, Level A recommendation) 1
• Coordination of care along the continuum of heart failure and throughout the chain of care is key to successful management 1

Core Components of Heart Failure Management

Medical Staff Requirements

• Tertiary/teaching/university hospital centers should have cardiology staff with specific interest and expertise in heart failure 1
• Secondary referral centers should ensure at least one cardiologist has a specialist interest in heart failure 1
• Primary care physicians play a significant role in managing heart failure and should be integrated into the multidisciplinary team 1, 2

Essential Program Elements

• Optimized medical and device management 1
• Patient education with emphasis on adherence and self-care 1
• Regular follow-up after discharge (clinic and/or home-based visits) 1
• Increased healthcare access through in-person follow-up and telephone contact 1
• Facilitated access to care during decompensation episodes 1
• Assessment of and intervention for changes in weight, nutritional status, functional status, and quality of life 1
• Access to advanced treatment options 1
• Psychosocial support for patients and families/caregivers 1

Pharmacological Management

• Neurohormonal antagonists (ACEIs, MRAs, and beta-blockers) improve survival in patients with HFrEF and are recommended for every eligible patient 1
• Sacubitril/valsartan (ARNI) has been shown to be superior to ACE inhibitors in reducing mortality and hospitalization risk in eligible patients 3, 2
• Diuretics are essential for symptomatic treatment when fluid overload is present 1
• Ivabradine may be considered for patients with elevated heart rates despite beta-blocker therapy 1, 4

Non-Pharmacological Interventions

• Exercise training and cardiac rehabilitation improve quality of life 5
• Self-care interventions and education about symptom monitoring are crucial 1
• Smoking cessation and alcohol intake reduction are recommended to prevent or delay heart failure onset (Class I, Level C) 1
• Treatment of depression can help improve quality of life 5

Palliative and Supportive Care

• Palliative care should be integrated into heart failure management, particularly for patients with refractory symptoms, facing major medical decisions, or with multimorbidity 1
• Discussions about goals of care and preferences for end-of-life care should be included in advance care planning 1
• Heart failure symptoms should be assessed and managed throughout the course of the disease to the end of life 1
• For patients with devices, preferences regarding deactivation should be part of advance care planning 1

Quality Improvement Approaches

• Disease-management systems view heart failure as a chronic illness spanning home, outpatient, and inpatient settings 1
• Performance measures can be used to assess and improve quality of care 1
• Multifactorial interventions that simultaneously address different barriers to change tend to be more successful than isolated efforts 1

Common Pitfalls to Avoid

• Inadequate diuresis in volume-overloaded patients 6
• Failure to uptitrate medications to target doses 6
• Neglecting patient education and self-care strategies 6
• Inadequate transitional care planning leading to early readmissions 6
• Viewing heart failure as "stable" when it is often progressively worsening without obvious symptoms 2

Heart failure management requires ongoing vigilance and adjustment of therapies as the disease progresses. The multidisciplinary approach, with its focus on both pharmacological and non-pharmacological interventions, provides the best framework for improving both survival and quality of life in patients with heart failure.