A recent study out of the U.K. suggests that multidisciplinary team management could significantly reduce death or rehospitalization risk for HF patients across the LVEF spectrum.
- Specialist heart failure care involves management by specialist nurses under direct cardiologist supervision.
- This approach is traditionally reserved primarily for HFrEF patients who have the most proven guideline-directed medical therapies available.
- However, recent studies demonstrating SGLT2i and finerenone efficacy in HFmrEF/HFpEF has expanded the therapeutic options for specialist care beyond HFrEF.
Based in a single U.K. county, the Buckinghamshire analysis examined 2.1k patients hospitalized for acute heart failure who received either specialist care or standard care over a 618-day follow-up and found some striking outcome differences…
- Specialist care reduced the composite risk of death or HF rehospitalization across all LVEF categories: HFrEF (HR 0.58), HFmrEF (HR 0.49), and HFpEF (HR 0.76).
- Despite clear benefits, only 61% of discharge survivors received specialist outpatient care, with disparities between HFrEF (79%), HFmrEF (77%), and HFpEF (53%) patients.
- Overall outcomes were concerning: 63% died and 21% were rehospitalized for acute HF over follow-up, with 68% experiencing either endpoint.
Given the expanding HF population and increasing treatment complexity, the specialist nursing capacity, both in the U.K. and U.S. could be inadequate for population needs, especially since other specialist care implementation barriers persist.
- Among those with specialist care arranged, 38% missed their first appointment, highlighting implementation challenges beyond care availability.
- The population distribution (55% HFpEF, 36% HFrEF, 9% HFmrEF) suggests that current HFrEF-focused services also miss the majority of HF patients who could benefit from specialist care.
So where do we go from here? Currently, the British Society for Heart Failure argues that at least four specialist nurses per 100k people are needed to address growing treatment complexity and aging demographics.
- Further restructuring of HF care teams and understanding that all types of HF patients benefit from specialist care will also be necessary to move the needle on practice opinions.
The Takeaway
Heart failure comes in many forms in many different types of patients, but that doesn’t mean that only one subset of the disease should receive multidisciplinary care. This small, but important study raises the point that both having enough care providers and the right approach will be critical to improving HF care in the long run.
