Hospitalization of Patients With (But Not for) Heart Failure: An Opportunity for Accelerated Guideline-Directed Medical Therapy Optimization?

Abstract

For every primary hospitalization for heart failure (HF) in the United States, there are approximately 3.5 hospitalizations where HF is listed as a secondary diagnosis. 1 Jackson Sandra L. Xin Tong King Raymond J. Fleetwood Loustalot Yuling Hong Ritchey Matthew D National burden of heart failure events in the United States, 2006 to 2014. Circulation Heart Fail. 2018; 11e004873 PubMed Google Scholar Large-scale registries, such as the Get With The Guidelines-Heart Failure program (ClinicalTrials.gov Identifier: NCT02693509), include patients with HF admitted for either primary (acutely decompensated HF) or secondary (admitted for other reasons) diagnoses. Although guidelines acknowledge the importance of tailored management of patients hospitalized with decompensated HF, limited guidance is provided for the much greater number of hospitalizations where HF is a secondary diagnosis. This framework may originate from the notion that hospitalization is currently structured to address primary admission indications, reimbursement and quality metrics are linked to primary diagnoses, and limited resources are devoted to treatment of concomitant chronic diseases during hospital admission. Given the frequency of secondary HF hospitalizations, we explore a paradigm where hospitalization goals are restructured in the IMPLEMENT-HF study: treating presenting conditions while also optimizing background therapies for chronic HF via dedicated, multidisciplinary HF care teams (Fig. 1). Such an approach may improve outcomes and challenge the notion of sharply defined “acute” and “chronic” states in patients with HF.