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

Heart failure is a leading cause of healthcare expenditure in the United States (U.S.), with both costs and prevalence expected to increase. Heart failure is uniquely suited to high-value practices that incentivize longitudinal risk-factor modification and care coordination. The objective of this review is to consolidate evidence for high-value practices in heart failure management and propose an ideal cross-continuum heart failure care model. High-value management of patients with stage A and B heart failure includes lifestyle modifications, risk factor identification and treatment, and select guideline-directed medical therapy (GDMT), with early integration of ambulatory specialty care. Patients with symptomatic (stage C) heart failure benefit from wraparound care, implementation of evidence-based GDMT, and early identification of stage D heart failure. Palliative care and advanced heart failure referrals clarify trajectory and avoid excessive cost. Although fragmented payment models and episodic outcome measurements represent barriers, an emphasis on a high-value care delivery philosophy will help health systems of tomorrow provide interdisciplinary, integrated, and longitudinal heart failure care. Systems may benefit from moving beyond end-stage outcomes, such as readmissions, to identifying metrics valuing cross-continuum integration.