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 reduces
the hospitalization rate for HF and healthcare costs and improves adherence to self-care
and utilization of GDMT. This manuscript 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 redundancy of clinical responsibilities
among team members, and improve clinical outcomes and patient satisfaction in their
HF care.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiac FailureAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Heart Failure. CDC, 2020. Accessed 11/17/2021, 2021, at https://www.cdc.gov/heartdisease/heart_failure.htm.
- 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2022; 145: e895-e1032
- The impact of a community-based heart failure multidisciplinary team clinic on healthcare utilization and costs.ESC Heart Fail. 2022; 9: 676-684
- Risk score-guided multidisciplinary team-based Care for Heart Failure Inpatients is associated with lower 30-day readmission and lower 30-day mortality.Am Heart J. 2020; 219: 78-88
- Systematic review of multidisciplinary interventions in heart failure.Heart. 2005; 91: 899-906
- Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials.J Am Coll Cardiol. 2004; 44: 810-819
- Effectiveness of the Pharmacist-Involved Multidisciplinary Management of Heart Failure to Improve Hospitalizations and Mortality Rates in 4630 Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.J Card Fail. 2019; 25: 744-756
- Multidisciplinary management of chronic heart failure: principles and future trends.Clin Ther. 2015; 37: 2225-2233
- Assessing the Quality and Comparative Effectiveness of Team-Based Care for Heart Failure: Who, What, Where, When, and How.Heart Fail Clin. 2015; 11: 499-506
- Team-Based Care for Managing Cardiac Comorbidities in Heart Failure.Heart Fail Clin. 2015; 11: 407-417
- Team-Based Care for Outpatients with Heart Failure.Heart Fail Clin. 2015; 11: 379-405
- Team-based Care for Patients Hospitalized with Heart Failure.Heart Fail Clin. 2015; 11: 359-370
- Multidisciplinary team approach to heart failure management.Heart. 2018; 104: 1376-1382
- Team-based Care for Advanced Heart Failure.Heart Fail Clin. 2015; 11: 467-477
- Cost/utility ratio in chronic heart failure: comparison between heart failure management program delivered by day-hospital and usual care.J Am Coll Cardiol. 2002; 40: 1259-1266
- Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort - The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care).Int J Cardiol. 2015; 201: 368-375
- 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee.J Am Coll Cardiol. 2019; 74: 1966-2011
- Evidence-based nursing: the role of the advanced practice registered nurse in the management of heart failure patients in the outpatient setting.Dimens Crit Care Nurs. 2010; 29: 57-62
- Roadmap for the management of heart failure patients during the vulnerable phase after heart failure hospitalizations: how to implement excellence in clinical practice.J Cardiovasc Med (Hagerstown). 2022; 23: 149-156
- Evaluation of a nurse practitioner disease management model for chronic heart failure: a multi-site implementation study.Congest Heart Fail. 2012; 18: 64-71
- Transitions of care in heart failure: a scientific statement from the.American Heart Association. Circ Heart Fail. 2015; 8: 384-409
- Effectiveness of Telemedicine visits in reducing 30-Day Readmissions Among Patients with Heart Failure During the COVID-19 Pandemic.J Am Heart Assoc. 2022; 11e023935
- Discharge counseling for patients with heart failure or myocardial infarction: a best practices model developed by members of the American College of Clinical Pharmacy's Cardiology Practice and Research Network based on the Hospital to Home (H2H) Initiative.Pharmacotherapy. 2013; 33: 558-580
- The role of the clinical pharmacist in the care of patients with cardiovascular disease.J Am Coll Cardiol. 2015; 66: 2129-2139
- Clinical pharmacy services in heart failure: an opinion paper from the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network.J Card Fail. 2013; 19: 354-369
- Nutrition, Obesity, and Cachexia in Patients With Heart Failure: A Consensus Statement from the Heart Failure Society of America Scientific Statements Committee.J Card Fail. 2019; 25: 380-400
- Associations between cachexia and metalloproteinases, haemodynamics and mortality in heart failure.Eur J Clin Invest. 2021; 51: e13426
- Impact of sarcopenia on prognosis in patients with heart failure with reduced and preserved ejection fraction.Eur J Prev Cardiol. 2021; 28: 1022-1029
- Relation of preoperative serum albumin levels to survival in patients undergoing left ventricular assist device implantation.Am J Cardiol. 2013; 112: 1484-1488
- Academy of Nutrition and Dietetics Evidence-Based Practice Guideline for the Management of Heart Failure in Adults.J Acad Nutr Diet. 2018; 118: 2331-2345
- A multi-modal intervention in management of left ventricular assist device outpatients: dietary counselling, controlled exercise and psychosocial support.Eur J Cardiothorac Surg. 2012; 42: 1026-1032
- Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure.Phys Ther. 2020; 100: 14-43
- Frailty and outcomes after implantation of left ventricular assist device as destination therapy.J Heart Lung Transplant. 2014; 33: 359-365
- The impact of frailty on mortality after heart transplantation.J Heart Lung Transplant. 2021; 40: 87-94
- Frailty Is Intertwined With Heart Failure: Mechanisms, Prevalence, Prognosis, Assessment, and Management.JACC Heart Fail. 2019; 7: 1001-1011
- Cardiac Rehabilitation for Patients With Heart Failure: JACC Expert Panel.J Am Coll Cardiol. 2021; 77: 1454-1469
- The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Official Adult Heart Transplant Report–2013; focus theme: age.J Heart Lung Transplant. 2013; 32: 951-964
- Calculated panel-reactive antibody predicts outcomes on the heart transplant waiting list.J Heart Lung Transplant. 2017; 36: 787-796
- The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients.J Heart Lung Transplant. 2010; 29: 914-956
- Report from a consensus conference on the sensitized patient awaiting heart transplantation.J Heart Lung Transplant. 2009; 28: 213-225
- Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association.Circulation. 2016; 134: e198-e225
- Integration of a palliative approach into heart failure care: a European Society of Cardiology Heart Failure Association position paper.Eur J Heart Fail. 2020; 22: 2327-2339
- Palliative Inotropes in Advanced Heart Failure: Comparing Outcomes Between Milrinone and Dobutamine.J Card Fail. 2022; 28: 1683-1691
- The Impact of a High-risk Psychosocial Assessment on Outcomes After Durable Mechanical Circulatory Support.ASAIO J. 2021; 67: 436-442
- Recommendations for Psychosocial Evaluation of VAD candidates: Adoption, completion, and barriers to implementation.Heart Lung. 2021; 51: 52-58
- The Approach to the Psychosocial Evaluation of Cardiac Transplant and Mechanical Circulatory Support Candidates.Curr Heart Fail Rep. 2019; 16: 201-211
- The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates for Long-term Mechanical Circulatory Support.Psychosomatics. 2018; 59: 415-440
- Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation: A Systematic Review and Meta-Analysis.Transplantation. 2015; 100: 988-1003
- The Predictive Value of Depression in the Years After Heart Transplantation for Mortality During Long-Term Follow-Up.Psychosom Med. 2019; 81: 513-520
- Cognitive Decline and Risk of Dementia in Individuals With Heart Failure: A Systematic Review and Meta-analysis.J Card Fail. 2021; 28: 1337-1348
- Long-Term Neurocognitive Outcome in Patients With Continuous Flow Left Ventricular Assist Device.JACC Heart Fail. 2021; 9: 839-851
- Neurological complications of heart failure.Handb Clin Neurol. 2021; 177: 77-89
- Cognition predicts days-alive-out-of-hospital after LVAD implantation.Int J Artif Organs. 2021; 44: 952-955
- Predicting post-LVAD outcome: Is there a role for cognition?.Int J Artif Organs. 2021; 44: 237-242
- Cerebral Microembolization in Left Ventricular Assist Device Associated Ischemic Events.J Stroke Cerebrovasc Dis. 2020; 29104660
- Long-term outcomes following thrombectomy for acute ischemic stroke in patients with a left ventricular assist device: a case series and literature review.Acta Neurochir (Wien). 2018; 160: 1729-1735
- Perioperative management of patients with undergoing durable mechanical circulatory support.Ann Transl Med. 2020; 8: 830
- Can a Left Ventricular Assist Device in Individuals with Advanced Systolic Heart Failure Improve or Reverse Frailty?.J Am Geriatr Soc. 2017; 65: 2383-2390
- Cognition and adherence are self-management factors predicting the quality of life of adults living with a left ventricular assist device.J Heart Lung Transplant. 2017; 36: 325-330
- Trajectories of self-care agency and associated factors in lung transplant recipients over the first 12 months following transplantation.Clin Transplant. 2017; : 31
- Advancing the Science of Self-Management in Adults With Long-Term Left Ventricular Assist Devices.Artif Organs. 2018; 42: 1095-1103
- Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association.Circulation. 2021; 143: e763-e783
- Depressive symptoms at 1 year after surgery increase the risk of cardiac allograft vasculopathy and mortality in heart transplant recipients: A prospective cohort study.Gen Hosp Psychiatry. 2021; 71: 20-26
- Team-based Palliative and End-of-life Care for Heart Failure.Heart Fail Clin. 2015; 11: 479-498
- Psychosocial needs and interventions for heart failure patients and families receiving palliative care support: a systematic review.Heart Fail Rev. 2017; 22: 565-580
- Medication adherence in cardiovascular medicine.BMJ. 2021; 374: n1493
- Revising project re-engineered discharge (RED): the impact of a pharmacist telephone intervention on hospital readmission rate.Pharmacotherapy. 2015; 35: 805-812
- 2020 ACC/AHA clinical performance and quality measures for adults with heart failure: a report of the American College of Cardiology/American Heart Association Task Force on performance meaures.J Am Coll Cardiol. 2020; 76: 2527-2564
National quality forum. Cardiovascular standing committee. Accessed 7/18, 2022 at https://www.qualityforum.org/ProjectMeasures.aspx?projectID=86074&cycleNO=1&cycleYear=2019
- 2021 ACC/AHA key data elements and definitions for heart failure: a report of the American College of Cardiology/American Heart Association Task Force on clinical data standards (writing committee to develop clinical data standards for heart failure).Circ Cardiovasc Qual Outcomes. 2021; 14e000102
Organ Procurement and Transplantation Network Bylaws. U.S. Department of Health & Human Services, 2021. Accessed 5/7, 2022, at, https://optn.transplant.hrsa.gov/policies-bylaws/bylaws/.
Get with the guidelines® - heart failure overview. American Heart Association. Accessed 8/19, 2022 at https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelines-heart-failure/get-with-the-guidelines-heart-failure-overview.
- A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure.N Engl J Med. 1995; 333: 1190-1195
- Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team: results of the Pharmacist in Heart Failure Assessment Recommendation and Monitoring (PHARM) Study.Ach Intern Med. 1999; 159: 1939-1945
- A randomized trial of the efficacy of multidisciplinary care in heart failure outpatients at high risk of hospital readmission.J Am Coll Cardiol. 2002; 39: 471-480
- Impact of care at a multidisciplinary congestive heart failure clinic: a randomized trial.CMAJ. 2005; 173: 40-45
- Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure: the Interdisciplinary Network for Heart Failure (INH) study.Circ Heart Fail. 2012; 5: 25-35
- Multidisciplinary group clinic appointments: the Self-Management and Care of Heart Failure (SMAC-HF) trial.Circ Heart Fail. 2014; 7: 888-894
- Effect of multidisciplinary disease management for hospitalized heart failure under a national health insurance programme.J Cardiovasc Med (Hagerstown). 2015; 16: 616-624
- Effectiveness of a multidisciplinary disease management program on outcomes in patients with heart failure in China: A randomized controlled single center study.Heart Lung. 2018; 47: 24-31
- ETHELRED investigators. Influence of risk on reduction of readmission and death by disease management programs in heart failure.J Card Fail. 2019; 25: 330-339
- Pharmacy-based interdisciplinary intervention for patients with chronic heart failure: results of the PHARM-CHF randomized controlled trial.Eur J Heart Fail. 2019; 21: 1012-1021
Article info
Publication history
Accepted:
February 5,
2023
Received in revised form:
February 1,
2023
Received:
September 15,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
