Why the study?
Heart failure is a major burden in Saudi Arabia, where care gaps persist and the implementation of multidisciplinary disease management programs remains inconsistent across the Kingdom.
This position statement provides a pragmatic, scalable framework for implementing multidisciplinary heart failure management programs tailored to the Saudi healthcare system.
Adoption of the tiered HF-DMP framework may improve coordination and outcomes in Saudi Arabia; extends international evidence with locally adapted pathways and metrics.
Background: Heart failure (HF) represents a major and growing health burden in Saudi Arabia, with high morbidity, frequent hospitalizations, and substantial system-level costs. Despite advances in guideline-directed medical therapy, gaps in diagnosis, care coordination, and longitudinal management persist. Structured, multidisciplinary heart failure–specific disease management programs (HF-DMPs) have been shown to improve outcomes and healthcare efficiency, yet their implementation remains inconsistent across the Kingdom. Methods: The Saudi Heart Association (SHA) convened a multidisciplinary expert panel to develop a national position statement on HF-DMPs. Recommendations were formulated through structured consensus, informed by a comprehensive review of international guidelines, clinical trials, real-world evidence, and Saudi-specific data. Results and conclusions: The SHA recommends a patient-centered, multidisciplinary HF-DMP framework aligned with disease stage and institutional capacity. Core components include structured referral and return-of-care pathways, integration of primary care as longitudinal care owners, optimized use of multidisciplinary teams, and scalable models incorporating virtual care and home-based services. Special populations, including cardio-oncology, pregnancy-associated HF, and cardiomyopathies, are addressed through adaptive multidisciplinary pathways. Performance indicators and quality metrics are proposed to support benchmarking and continuous improvement. Crucially, this framework is designed to synergize with the Kingdom’s Model of Care, ensuring that these clinical recommendations also offer a practical tool for the new healthcare system. Implementation of structured, capacity-based HF-DMPs is recommended as a pragmatic and scalable approach to enhance care coordination, optimize resource utilization, and reduce preventable HF morbidity and hospitalization at a national level.
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Bakhsh et al. (2026) conducted a review in Heart Failure. Heart failure-specific disease management programs (HF-DMPs) was evaluated. The Saudi Heart Association recommends a patient-centered, multidisciplinary heart failure disease management program framework aligned with disease stage and institutional capacity.
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