From the Guidelines
A referral to cardiology is warranted for a newly diagnosed heart failure patient to confirm the diagnosis, determine the underlying etiology, assess disease severity, and establish an appropriate treatment plan. This approach is supported by the most recent guidelines, including the 2022 AHA/ACC/HFSA guideline for the management of heart failure, which recommends timely referral for HF specialty care to review HF management and assess suitability for advanced HF therapies 1. The cardiologist will typically perform a comprehensive evaluation, including echocardiography to measure ejection fraction, which helps classify the heart failure as reduced (HFrEF) or preserved (HFpEF) ejection fraction. This classification guides medication choices, such as ACE inhibitors or ARBs, beta-blockers, mineralocorticoid receptor antagonists, and possibly newer agents like SGLT2 inhibitors for HFrEF patients.
The European Society of Cardiology Heart Failure Association standards for delivering heart failure care also emphasize the importance of specialist-led care, highlighting that HF outcomes are better for patients when they are admitted under specialist cardiology medical staff 1. Additionally, disease management programs for HF have demonstrated positive results, including a reduction in rehospitalization, improved quality of life, and lengthened life expectancy 1.
Key aspects of cardiology referral for newly diagnosed heart failure patients include:
- Confirming the diagnosis and determining the underlying etiology
- Assessing disease severity and establishing an appropriate treatment plan
- Evaluating the need for device therapy, such as implantable cardioverter-defibrillators or cardiac resynchronization therapy
- Implementing lifestyle modifications tailored to the patient's specific condition and needs
- Providing specialized monitoring and addressing comorbidities to improve outcomes.
From the Research
Referral to Cardiology for Newly Diagnosed Heart Failure Patients
- A referral to cardiology for a newly diagnosed heart failure patient is supported by several studies, which highlight the importance of guideline-directed medical therapy (GDMT) in improving outcomes for these patients 2, 3.
- The study by 2 found that baseline heart rate was a predictor of cardiac functional recovery in newly diagnosed heart failure patients with reduced ejection fraction, and that GDMT can predict left ventricular recovery.
- Another study by 3 found that being seen in a heart failure clinic was independently associated with the initiation of new GDMT, suggesting the potential benefit of referral to a heart failure clinic for patients with newly diagnosed heart failure.
- The American Heart Association provides guidance for the timely and appropriate referral of patients with advanced heart failure, emphasizing the importance of early recognition and referral to optimize care 4.
- A cross-sectional study found that there are substantial variations in entry criteria for heart failure clinics, leading to variations in whom providers refer for these life-saving services, and that publicizing evidence-based criteria and applying them systematically at referral sources could support improved heart failure patient care journeys and outcomes 5.
- A population-based study found that many patients with suspected new-onset chronic heart failure do not receive prompt cardiology care, and that older patients, women, and those with lower comorbidity and socioeconomic status had significantly longer times to cardiology consultation 6.
Key Factors Influencing Referral
- Guideline-directed medical therapy (GDMT) is a key factor in improving outcomes for heart failure patients, and referral to a cardiologist or heart failure clinic can increase the likelihood of patients receiving GDMT 2, 3.
- Baseline heart rate and left ventricular ejection fraction are important predictors of cardiac functional recovery in newly diagnosed heart failure patients, and can inform referral decisions 2.
- Patient characteristics, such as age, sex, and socioeconomic status, can influence the timing and likelihood of cardiology consultation, and may require targeted interventions to improve equity of access 6.