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Heart failure (HF) is a chronic heterogeneous clinical syndrome that is unified by the presence of clinical signs and symptoms of congestion and by the difficulty of its diagnosis and management. Its prevalence, of 6.5 million people in the USA,1 is rising due to an increasing incidence and to advances in medical, interventional and device therapies which extend the longevity of the affected patients. Despite these advances, HF is characterised by intermittent and recurrent exacerbations, which are associated with high morbidity, mortality and costs. The estimated costs of HF care are 40 billion dollars annually in the USA, from which >10 billion are due to hospital admissions after presentation to an emergency department (ED).2 Currently, the care paradigm for patients with HF is dichotomous, divided between the care of patients with chronic compensated HF in the outpatient setting and acute decompensated heart failure (ADHF) in an inpatient setting. Patients with compensated HF are managed longitudinally in outpatient clinics, including HF cardiology clinic, general cardiology clinic and primary care clinics. Traditionally, each of these clinics exist as independent ‘silos’ with limited direct communication between them. Furthermore, they are designed, staffed and supplied to provide traditional outpatient care, with limited ability to intervene in a rapid or invasive way. This is clearly focused on the evaluation and management of compensated patients.
Perhaps it is not surprising that ADHF accounts for over 1 million annual ED presentations in the USA.2 When a patient with ADHF presents to any of the above-mentioned clinical offices, there is a limited infrastructure and capabilities to address their acute needs. For a mild decompensation, oral diuretics may be adjusted with a plan for follow-up laboratories and phone calls. For a more severe decompensation, a patient may be directly admitted to the hospital or referred to the nearest ED. More …
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