Management of heart failure: are specialists really needed?

This editorial refers to ‘Extended heart failure clinic follow-up in low-risk patients: a randomized clinical trial (NorthStar)’, by M. Schou et al. , doi:10.1093/eurheartj/ehs235 Heart failure (HF) is regarded as one of the major medical challenges of our time given the increasing prevalence and impaired quality of life, high morbidity, mortality, and socio-economic burden.1 As a consequence, disease management programmes for patients with HF have been implemented in many countries.2 The goal of these programmes is to optimize care and to deal with the complexity of the management of HF in a multiprofessional manner and, thereby, improve patient adherence and decrease hospital readmission and mortality.3–5 As a part of these programmes, HF outpatient clinics (HFCs) have been established which usually include a specialized HF cardiologist, HF nurses, and other HF-related experts.2 The basic tasks of these HFCs include diagnostic services, establishment of an optimal evidence-based drug therapy, and patient education on the disease per se and on self-care behaviours.6 This understanding of fundamental HF care was substantially extended recently. Figure 1 illustrates the complexity of HF management. Based on the development of devices, and interventional and surgical therapies, HF specialists are increasingly challenged with new tasks.7 New implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization devices (CRT) offer the possibility to measure diagnostic variables such as intrathoracic impedance as a variable of thoracic fluid content which helps to optimize diuretic therapy.8 The high burden of co-morbidities such as renal failure or chronic obstructive pulmonary disease (COPD) requires a close cooperation with other specialists (e.g. nephrologists or respiratory physician) to treat HF patients optimally.9 Psychosocial disorders including depression and cognitive dysfunction are increasingly recognized which need specific care by psychologists.10,11 Furthermore, …