A high-value, cross-continuum approach to heart failure: A narrative review

Area of Science:

• Cardiology
• Health Services Research
• Public Health

Background:

• Heart failure (HF) is a major driver of U.S. healthcare costs, with increasing prevalence.
• HF management is well-suited for high-value care models emphasizing risk factor modification and care coordination.
• Current care models face challenges from fragmented payment and episodic outcome measurement.

Purpose of the Study:

• To review evidence supporting high-value practices in heart failure management.
• To propose an optimal cross-continuum heart failure care model.

Main Methods:

• Literature review consolidating evidence for high-value heart failure practices.
• Development of a proposed integrated care model spanning all HF stages.

Main Results:

• Stage A/B HF management: lifestyle changes, risk factor treatment, guideline-directed medical therapy (GDMT), and early specialty care.
• Stage C HF management: comprehensive care, evidence-based GDMT, and early identification of Stage D.
• Stage D HF management: palliative care and advanced HF referrals to clarify prognosis and reduce costs.

Conclusions:

• A high-value care philosophy is essential for future interdisciplinary, integrated, and longitudinal HF care.
• Shifting focus from end-stage outcomes (e.g., readmissions) to cross-continuum integration metrics is beneficial.
• Implementing a coordinated, high-value model can optimize HF patient care and resource utilization.