A Critical Evaluation of Patient Pathways and Missed Opportunities in Treatment for Heart Failure

Abstract

Background: Heart failure (HF) is a global problem responsible for significant morbidity and mortality. Methods: This review describes the patient pathways and missed opportunities related to treatment for patients with HF. Results: The contemporary management strategies in HF, including medical therapies, device therapy, transplant, and palliative care. Despite the strong evidence base for therapies that improve prognosis and symptoms, there remains a large number of patients that are not optimally managed. The treatment of patients with HF is highly influenced by those who are caring for them and varies widely across geographical regions. HF patients can be broadly classified into two key groups: those who have known HF, and those who are incidentally found to have reduced left ventricular systolic dysfunction or other cardiac abnormality when an echocardiogram is performed. While all patients are under the care of a general practitioner or family doctor, in other instances, non-cardiologist physicians, cardiologists, and specialist HF nurses—each will have varying levels of expertise in managing HF—are part of the broader team involved in the specialist management of patients with HF. Conclusions: There are many potential missed opportunities in HF treatment, which include general opportunities, medications, etiology-specific therapy, device therapy, therapies when initial treatments fail, and palliative care.