Risk Stratification Tools in Acute Heart Failure and Their Roles in Personalized Follow-Up

Figures

• 

  Figure 1. Personalized follow-up plan in HFrEF. Post-discharge follow-up plan is guided by multiparametric risk stratification. In the presence of high-risk features, such as AdvHF or WHF, residual congestion, insufficient reduction in NP levels or multiple comorbidities and frailty, a close (within 2 weeks) and intensive follow-up strategy is appropriate. In patients with I NEED HELP criteria, referral to an advanced HF centre is essential. Patients without high-risk features can be considered at low risk and should undergo GDMT titration by a nursing-led program shared with a cardiologist. At three months medical re-evaluation is needed, both in low and high-risk patients, to define patient’s trajectory and consider device implantation. Personalized follow-up should continue up to clinical stabilization (at least 6 months).

• 

  Figure 2. Personalized follow-up plan in HFmrEF and HFpEF. Multiparametric risk stratification guides the follow-up plan. In the presence of high-risk features, such as AdvHF or WHF, residual congestion, insufficient reduction in NP levels or multiple comorbidities and frailty, a more intensive follow-up strategy is warranted. This includes close clinical re-evaluation within 2 weeks and thereafter up to 3 months as needed. Patients without high-risk features can be considered at low risk. These individuals can be managed collaboratively with the community physician in the early post-discharge period, with further assessment by a cardiologist scheduled between 3–6 months. Regardless of the risk level, a multidisciplinary approach and a hospital-community integrated model should be applied to ensure comprehensive management of comorbidities. Should a patient develop WHF with progression to HFrEF phenotype, management should follow the pathway outlined in Figure 1. In presence of AdvHF, referral to an advanced HF centre is essential.