Developing a disease management program for the improvement of heart failure outcomes: the do’s and the don’ts

ABSTRACT

Introduction: Heart failure is a highly prevalent condition affecting approximately 2% of people worldwide. Heart failure disease management programs (DMP) have shown a reduction in mortality and reduced hospitalization and are an established part of clinical guidelines; however, their presence is not widespread. Focusing on the application of proven therapies, patient education, diagnosis with work up of cause and easy access for clinical deterioration should be fundamental to the structure of the DMP. Multidisciplinary team care with early and timely recognition of potentially critical patients is essential, along with the inclusion of patients diagnosed in hospital as well as the community.

Areas covered: The fundamental structure of a DMP along with the current gaps in evidence is outlined. Current challenges with the heart failure condition along with the current best evidence are covered. Articles were searched using MEDLINE containing the keywords; Chronic Heart Failure, Disease Management Program. We have also provided clinical opinion.

Expert opinion: A multidisciplinary approach to disease management programs is essential to providing adequate care to patients. DMPs are an established part of current guidelines and should be a benchmark of treatment. Future resources should be focused on identifying patients at risk and early prevention.

KEYWORDS:

• Chronic heart failure
• disease management program
• heart failure/therapy
• heart failure/diagnosis
• patient-centred care

Article highlights

• HF is one of the most common conditions worldwide with DMPs being a clinical cornerstone of managing the condition but are not widespread.

• The medical and economic burden of the disease processes involved are an enormous strain on the patient and society. This challenge requires a multidisciplinary approach to care. This includes a cardiology-led service with different specialties linked between primary care and the hospital setting allowing early recognition of clinical deterioration.

• Many DMPs’ focus is often with the most critical patients resulting in a lack of care with diagnosing and preventative therapies with more stable patients.

• DMPs should focus on the application of proven therapies, self-education, diagnosis with workup of cause and easy access for clinical deterioration.

• DMPs should provide service to patients in the form of an annual review of stable patients, post-hospital discharge service, titration of medications, a review of community-diagnosed patients and a greater awareness of the problems faced with the HF-PEF population. The future expectation would ultimately be a seamless interlink of these services.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.