The Role of Cardiologists in the Management of Patients with Heart Failure

  • Vera Maria Avaldi
  • Jacopo LenziEmail author
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1067)


Heart failure is a complex clinical syndrome with a remarkable impact on health care systems in terms of patients’ morbidity and mortality, as well as direct and indirect costs. It is essential to redesign models of care for patients with heart failure that are tailored on personalized health care needs and carried out in the most appropriate setting. There is some debate about the role of cardiologists in the management of patients with heart failure. Indeed, results regarding the inclination of cardiologists’ patients to achieve better outcomes are controversial, given the heterogeneity of studies in terms of study design, population, setting and variables considered. The aim of this chapter is to describe and synthesize the current state of knowledge about the role of specialists in the management of patient with heart failure, and to assess whether there is a type of patients for which cardiologists demonstrate the greatest value or a setting of care where they add more benefit.


Heart failure Cardiologist care Mortality Readmissions 


  1. Ahmed A, Allman RM, Kiefe CI, Person SD, Shaneyfelt TM, Sims RV et al (2003) Association of consultation between generalists and cardiologists with quality and outcomes of heart failure care. Am Heart J 145(6):1086–1093. Scholar
  2. Al-Gobari M, El Khatib C, Pillon F, Gueyffier F (2013) β-blockers for the prevention of sudden cardiac death in heart failure patients: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 13:52. Scholar
  3. Ansari M, Alexander M, Tutar A, Bello D, Massie BM (2003) Cardiology participation improves outcomes in patients with new-onset heart failure in the outpatient setting. J Am Coll Cardiol 41(1):62–68. Scholar
  4. Auerbach AD, Hamel MB, Davis RB, Connors AF Jr, Regueiro C, Desbiens N et al (2000) Resource use and survival of patients hospitalized with congestive heart failure: differences in care by specialty of the attending physician. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Ann Intern Med 132(3):191–200. Scholar
  5. Ayanian JZ (2000) Generalists and specialists caring for patients with heart disease: united we stand, divided we fall. Am J Med 108(3):259–261. Scholar
  6. Bellotti P, Badano LP, Acquarone N, Griffo R, Lo Pinto G, Maggioni AP et al (2001) Specialty-related differences in the epidemiology, clinical profile, management and outcome of patients hospitalized for heart failure; the OSCUR study. Eur Heart J 22(7):596–604. Scholar
  7. Boom NK, Lee DS, Tu JV (2012) Comparison of processes of care and clinical outcomes for patients newly hospitalized for heart failure attended by different physician specialists. Am Heart J 163(2):252–259. Scholar
  8. Bueno H, Ross JS, Wang Y, Chen J, Vidán MT, Normand SL et al (2010) Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006. JAMA 303(21):2141–2147. Scholar
  9. Chowdhury R, Khan H, Heydon E, Shroufi A, Fahimi S, Moore C et al (2013) Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J 34(38):2940–2948. Scholar
  10. Corrao G, Ghirardi A, Ibrahim B, Merlino L, Maggioni AP (2015) Short- and long-term mortality and hospital readmissions among patients with new hospitalization for heart failure: a population-based investigation from Italy. Int J Cardiol 181:81–87. Scholar
  11. Di Lenarda A, Scherillo M, Maggioni AP, Acquarone N, Ambrosio GB, Annicchiarico M et al (2003) Current presentation and management of heart failure in cardiology and internal medicine hospital units: a tale of two worlds—the TEMISTOCLE study. Am Heart J 146(4):E12. Scholar
  12. Driscoll A, Meagher S, Kennedy R, Hay M, Banerji J, Campbell D et al (2016) What is the impact of systems of care for heart failure on patients diagnosed with heart failure: a systematic review. BMC Cardiovasc Disord 16(1):195. Scholar
  13. Dunlay SM, Roger VL (2014) Understanding the epidemic of heart failure: past, present, and future. Curr Heart Fail Rep 11(4):404–415. Scholar
  14. Ezekowitz JA, van Walraven C, McAlister FA, Armstrong PW, Kaul P (2005) Impact of specialist follow-up in outpatients with congestive heart failure. CMAJ 172(2):189–194. Scholar
  15. Ferrari R, Böhm M, Cleland JG, Paulus WJ, Pieske B, Rapezzi C et al (2015) Heart failure with preserved ejection fraction: uncertainties and dilemmas. Eur J Heart Fail 17(7):665–671. Scholar
  16. Fischer C, Steyerberg EW, Fonarow GC, Ganiats TG, Lingsma HF (2015) A systematic review and meta-analysis on the association between quality of hospital care and readmission rates in patients with heart failure. Am Heart J 170(5):1005–17.e2. Scholar
  17. Foody JM, Rathore SS, Wang Y, Herrin J, Masoudi FA, Havranek EP et al (2005) Physician specialty and mortality among elderly patients hospitalized with heart failure. Am J Med 118(10):1120–1125. Scholar
  18. Garin N, Carballo S, Gerstel E, Lerch R, Meyer P, Zare M et al (2012) Inclusion into a heart failure critical pathway reduces the risk of death or readmission after hospital discharge. Eur J Intern Med 23(8):760–764. Scholar
  19. Hansen LO, Young RS, Hinami K, Leung A, Williams MV (2011) Interventions to reduce 30-day rehospitalisation: a systematic review. Ann Intern Med 155(8):520–528. Scholar
  20. Indridason OS, Coffman CJ, Oddone EZ (2003) Is specialty care associated with improved survival of patients with congestive heart failure? Am Heart J 145(2):300–309. Scholar
  21. Jackevicius CA, de Leon NK, Lu L, Chang DS, Warner AL, Mody FV (2015) Impact of a multidisciplinary heart failure post-hospitalization program on heart failure readmission rates. Ann Pharmacother 49(11):1189–1196. Scholar
  22. Jhund PS, Macintyre K, Simpson CR, Lewsey JD, Stewart S, Redpath A et al (2009) Long-term trends in first hospitalization for heart failure and subsequent survival between 1986 and 2003: a population study of 5.1 million people. Circulation 119(4):515–523. Scholar
  23. Jong P, Gong Y, Liu PP, Austin PC, Lee DS, Tu JV (2003) Care and outcomes of patients newly hospitalized for heart failure in the community treated by cardiologists compared with other specialists. Circulation 108(2):184–191. Scholar
  24. Lee DS, Stukel TA, Austin PC, Alter DA, Schull MJ, You JJ et al (2010) Improved outcomes with early collaborative care of ambulatory heart failure patients discharged from the emergency department. Circulation 122(18):1806–1814. Scholar
  25. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K et al (2009) Heart disease and stroke statistics–2009 update: a report from the American Heart Association statistics committee and stroke statistics subcommittee. Circulation 119(3):480–486. Scholar
  26. Lowe J, Candlish P, Henry D, Wlodarcyk J, Fletcher P (2000) Specialist or generalist care? A study of the impact of a selective admitting policy for patients with cardiac failure. Int J Qual Health Care 12(4):339–345. Scholar
  27. Maggioni AP, Dahlström U, Filippatos G, Chioncel O, Leiro MC, Drozdz J et al (2013) EURObservational research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 15(7):808–817. Scholar
  28. Masters J, Morton G, Anton I, Szymanski J, Greenwood E, Grogono J et al (2017) Specialist intervention is associated with improved patient outcomes in patients with decompensated heart failure: evaluation of the impact of a multidisciplinary inpatient heart failure team. Open Heart 4(1):e000547. Scholar
  29. McAlister FA, Stewart S, Ferrua S, McMurray JJ (2004) Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol 44(4):810–819. Scholar
  30. Metra M, Teerlink JR (2017) Heart failure. Lancet. Scholar
  31. Mosterd A, Hoes AW (2007) Clinical epidemiology of heart failure. Heart 93(9):1137–1146. Scholar
  32. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18(8):891–975. Scholar
  33. Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM (1995) A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 333(18):1190–1195. Scholar
  34. Sakata Y, Nochioka K, Miura M, Takada T, Tadaki S, Miyata S et al (2013) Supplemental benefit of an angiotensin receptor blocker in hypertensive patients with stable heart failure using olmesartan (SUPPORT) trial—rationale and design. J Cardiol 62(1):31–36. Scholar
  35. Selim AM, Mazurek JA, Iqbal M, Wang D, Negassa A, Zolty R (2015) Mortality and readmission rates in patients hospitalized for acute decompensated heart failure: a comparison between cardiology and general-medicine service outcomes in an underserved population. Clin Cardiol 38(3):131–138. Scholar
  36. Starfield B, Chang H, Lemke KW, Weiner JP (2009) Ambulatory specialist use by non-hospitalized patients in US health plans: correlates and consequences. J Ambul Care Manage 32(3):216–225. Scholar
  37. Takeda A, Taylor SJ, Taylor RS, Khan F, Krum H, Underwood M (2012) Clinical service organisation for heart failure. Cochrane Database Syst Rev 9:CD002752. Scholar
  38. Uthamalingam S, Kandala J, Selvaraj V, Martin W, Daley M, Patvardhan E et al (2015) Outcomes of patients with acute decompensated heart failure managed by cardiologists versus noncardiologists. Am J Cardiol 115(4):466–471. Scholar
  39. Vaduganathan M, Fonarow GC, Gheorghiade M (2013) Drug therapy to reduce early readmission risk in heart failure: ready for prime time? JACC Heart Fail 1(4):361–364. Scholar
  40. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH et al (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation 128(16):e240–e327. Scholar
  41. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM et al (2017) 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Failure Society of America. Circulation 136:e137. Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Biomedical and Neuromotor SciencesAlma Mater Studiorum – University of BolognaBolognaItaly

Personalised recommendations