Review Article
Multidisciplinary Care in Heart Failure Services

https://doi.org/10.1016/j.cardfail.2023.02.011Get rights and content

Highlights

  • Heart failure (HF) guidelines currently recommend a multidisciplinary team approach for patients with HF.

  • A structured multidisciplinary HF approach should be incorporated to improve clinical and patient-centered outcomes.

  • This guidance should be helpful in implementing the structured multidisciplinary HF approach in the real-world practice.

Abstract

The American College of Cardiology/American Heart Association/Heart Failure Society of American 2022 guidelines for heart failure (HF) recommend a multidisciplinary team approach for patients with HF. The multidisciplinary HF team-based approach decreases the hospitalization rate for HF and health care costs and improves adherence to self-care and the use of guideline-directed medical therapy. This article proposes the optimal multidisciplinary team structure and each team member's delineated role to achieve institutional goals and metrics for HF care. The proposed HF-specific multidisciplinary team comprises cardiologists, surgeons, advanced practice providers, clinical pharmacists, specialty nurses, dieticians, physical therapists, psychologists, social workers, immunologists, and palliative care clinicians. A standardized multidisciplinary HF team-based approach should be incorporated to optimize the structure, minimize the redundancy of clinical responsibilities among team members, and improve clinical outcomes and patient satisfaction in their HF care.

Visual Take Home Graphics

Multidisciplinary HF service (general HF vs LVAD HF service vs transplant HF service). CT, cardiothoracic; HF, heart failure; LVAD, left ventricular assist device.

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Section snippets

Recommended Multidisciplinary Team Structure and HF Spectrum of Care

Patients diagnosed with HF typically begin their care with their primary care physicians, who often manage the care of these complex patients for an extended period of time owing to a lack of access to subspecialized care. Access to higher levels of care can be difficult in rural and underserved areas and results in a referral to a general cardiologist and then to HF specialists and a multidisciplinary team. Based on the complexity of each case, patients may eventually transition back to the

Physician Leaders

In HF programs with no advanced options available, the cardiologist serves as the leader of the multidisciplinary team and helps to coordinate the plan of care for patients. In the programs with the availability of mechanical circulatory support (MCS), especially durable VADs, and heart transplantation, a HF cardiologist and cardiothoracic surgeon often colead the team. They serve as medical and surgical directors of the VAD or VAD/transplant program. It is not unusual, especially in

Gaps in Knowledge

Although multidisciplinary care is vital and well-recognized in the management of the patients with HF, institutional resources to hire all essential professionals in each HF care model could be a limiting factor. Future studies are needed to evaluate the minimum number of essential professionals needed based on the HF services provided. For example, general HF practice may focus on GDMT optimization, which can be done by HF APP, pharmacists, or HFN under protocols. Second, having redundancy in

Conclusion

A multidisciplinary HF team-based approach is now recommended for patients with HF in the American College of Cardiology/American Heart Association/HFSA guidelines. This approach is beneficial to reducing the hospitalization rate for HF, improving adherence to self-care and GDMT, and potentially reducing health care costs. This expert guidance should help implement the structured multidisciplinary HF team-based approach in the real-world HF practice.

Lay Summary

The guidelines for HF recommend a multidisciplinary team approach for patients with HF. The HF team-based approach reduces the hospitalization rate for HF and health care costs and improves adherence to self-care and use of appropriate medications. This article proposes the optimal HF team structure and each team member's delineated role to achieve institutional goals and metrics for HF care. A structured HF team-based approach should be incorporated to optimize the structure, minimize

A proposed tweet

A structured multidisciplinary HF approach should be implemented to improve clinical and patient-centered outcomes.

Disclosure

The authors have no relationships with the industry and nothing to disclose.

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  • Cited by (0)

    Dr. Sokos and Dr. Kido contributed equally to this work and shar co-primary authorship.

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