A High-Value, Cross-Continuum Approach to Heart Failure: A Narrative Review

Area of Science:

• Cardiology
• Health Services Research
• Healthcare Management

Background:

• Heart failure (HF) represents a significant and growing burden on U.S. healthcare expenditures.
• HF management is amenable to high-value care models emphasizing long-term risk modification and coordinated care.
• Current care models often face fragmentation and focus on end-stage outcomes, necessitating a shift towards integrated, cross-continuum approaches.

Purpose of the Study:

• To review and synthesize evidence supporting high-value practices in heart failure management.
• To propose an optimized, cross-continuum model for heart failure care delivery.
• To identify strategies for overcoming barriers to high-value care implementation.

Main Methods:

• Literature review consolidating evidence on high-value heart failure management strategies.
• Analysis of current care delivery models and identification of best practices across the continuum of care.
• Proposal of an integrated, longitudinal care model for heart failure patients.

Main Results:

• Stage A and B HF management involves lifestyle changes, risk factor treatment, guideline-directed medical therapy (GDMT), and early specialty care integration.
• Stage C HF requires comprehensive support, evidence-based GDMT, and proactive identification of Stage D progression.
• Palliative and advanced HF referrals are crucial for trajectory clarification and cost containment.

Conclusions:

• A high-value care philosophy is essential for developing interdisciplinary, integrated, and longitudinal heart failure management systems.
• Shifting focus from episodic outcomes (e.g., readmissions) to metrics valuing cross-continuum integration is vital.
• Implementing such a model can enhance patient outcomes and optimize healthcare resource utilization.