European Society of Cardiology Heart Failure Association Standards for Delivering Heart Failure Care

Theresa A. McDonagh; Lynda Blue; Andrew L. Clark; Ulf Dahlström; Inger Ekman; Mitja Lainscak; Kenneth McDonald; Mary Ryder; Anna Strömberg; Tiny Jaarsma


Eur J Heart Fail. 2011;13(3):235-241. 

In This Article

Complexity of HF Care

It is evident that the management of the patient with suspected or confirmed HF is complex and that the numbers of patients involved are large and increasing. Patients are asked to make lifestyle changes, take multiple drugs, and are exposed increasingly to device therapy. In addition, the average age of an HF patient at diagnosis is 76 years—i.e. it is predominantly a 'cardio-geriatric syndrome'. Affected patients have frequent and multiple co-morbidities. The therapies themselves have numerous side effects. In the midst of all this, the HF patient has to make multiple visits to hospital clinics often seeing numerous doctors. This can sow the seeds of enormous confusion likely to result in patchy adherence to therapy.

It is obvious, therefore, that management cannot just be focused on one sector of care, as the HF patient can arrive in a number of health-care settings. Unfortunately, the diagnosis is still most often made during a hospital admission,[2,18] when the patient can present to the coronary care unit, a cardiology ward, a general internal medicine ward, or care of the elderly ward. Patients are also readmitted frequently, and during the hospital stay, they have a high mortality rate.[19–21] Of course, patients can also present to the general practitioner for diagnosis and survivors are discharged back into the community following admissions. Many health-care professionals with different types of expertise across a range of medical, nursing, and other professions allied to medicine together with support services in the community are thus needed to tackle HF for any given population. The need to organize services across traditional boundaries may explain why many in Europe are struggling with the implementation of organized HF care.