Heart Failure Clinics: Much More than Pharmacotherapy

S. T. Dodiyi-Manuel *

University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.

O. A. Ajala

University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.

E. Edafe

University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.

M. R. Akpa

University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.

*Author to whom correspondence should be addressed.


Introduction: Heart failure (HF) is a major cause of increased morbidity and mortality and its prevalence is expected to increase because of the aging population, increased prevalence of risk factors and improved post myocardial infarction survival. There is a relationship between high quality care and improved patient outcome particularly when the care is from specially trained providers. This has brought about the creation of disease specific clinics. The heart failure clinic (HFC) is established for many reasons which include, improvement of clinical outcomes, early detection of symptoms and identification of factors that may lead to progression of heart failure such as poor adherence, socioeconomic and psychological factors. The purpose of this study is to review the multidisciplinary approach to the management of heart failure through the heart failure clinic.

Materials and methods: A literature search using the database on Pubmed, Research gate, google scholar, Science direct, African Journal online and British Medical Journal was carried out using the key phrases; heart failure, heart failure clinic, management of heart failure.

conclusion: Optimization of guideline-directed medical therapy and the establishment of multidisciplinary heart failure clinics would address several domains of care. It aims to provide comprehensive patient management that would lead to reduced hospitalization and better patient outcomes, if appropriately implemented.

Keywords: Heart failure, pharmacotherapy, medical adherence, patient care

How to Cite

Dodiyi-Manuel, S. T., Ajala, O. A., Edafe, E., & Akpa, M. R. (2023). Heart Failure Clinics: Much More than Pharmacotherapy. Asian Journal of Cardiology Research, 6(1), 1–12. Retrieved from https://journalajcr.com/index.php/AJCR/article/view/126


Download data is not yet available.


Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics-2021 update: a report from the American heart association. Circulation. 2021;143(8):e254-e743.

Center for Medicare and Medicaid Services data compendium; 2020.


Konstam MA. Executive council of the heart failure society of America. Heart failure training: a call for an integrative, patient focused approach to an emerging cardiology subspecialty. J Am Coll Cardiol. 2004;44:1361- 1362.

McAlister FA, Stewart S, Ferrua S, et al. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol. 2004;44:810-819.

Adams KF, Lindenfeld J, Arnold JM, Baker D, Barnard DH, Baughman KL, et al. HFSA 2006 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2006; 12:1e119.

Gustafsson F, Arnold JMO. Heart failure clinics and outpatient management: review of the evidence and call for quality assurance. Eur Heart J. 2004;25:1596-1604.

Silver MA. The heart failure clinic. In: Hosenpud JD, Greenberg BH, editors. Congestive heart failure. 3rd ed. Philadelphia: Lippincott Williams & Wilkins. 2007;656-659.

Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult. Circulation. 2005;112:154-235.

Rich MW, Beckman V, Wittenberg C, et al. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995;333:1190-1195.

Gattis WA, Hasselblad V, Whellan DJ, O’Connor CM. Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team: results of the pharmacist in heart failure assessment recommendation and monitoring (PHARM) study. Arch Intern Med. 1999;159:1939-1945.

Grancelli H, Varini S, Ferrante D, Schwartzman R, Zambrano C, Soifer S, et al. Randomized trial of telephone intervention in chronic heart failure (DIAL): study design and preliminary observation. J Card Fail. 2003;9:172-179.

Ypenburg C, Bax JJ, van der Wall EE, Schalij MJ, van Erven L, et al. Intrathoracic impedance monitoring to predict decompensated heart failure. Am J Cardiol. 2007;99:554-557.

Oddone EZ, Weinberger M, Giobbie-Hurder A, Landsman P, Henderson W. Enhanced access to primary care for patients with congestive heart failure. Veterans affairs cooperative study group on primary care and hospital readmission. Effective Clin Practice. 1999; 2:201-209.

Williams SG, Ng LL, O’Brien RJ, Taylor S, Wright DJ, Li YF, et al. Complementary roles of simple variables, NYHA and N-BNP, in indicating aerobic capacity and severity of heart failure. Int J Cardiol 2005; 102:279-286.

Craig CL, Marshall AL, Sjo¨stro¨m M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003;35: 1381-1395.

Zugck C, Kruger C, Durr S, Gerber SH, Haunstetter A, Hornig K, et al. Is the 6-minute walk test a reliable substitute for peak oxygen uptake in patients with dilated cardiomyopathy? Eur Heart J. 2000;21:507-508.

Passantino A, Lagioia R, Mastropasqua F, Scrutinio D. Short-term change in distance walked in 6 min is an indicator of outcome in patients with chronic heart failure in clinical practice. J Am Coll Cardiol. 2006;48:99-105.

Corra U, Mezzani A, Bosimini E, Giannuzzi P. Prognostic value of time-related changes of cardiopulmonary exercise testing indices in stable chronic heart failure: a pragmatic and operative scheme. Eur J Cardiovasc Prev Rehabil. 2006;13:186-192.

Weber K, Janicki J. Cardiopulmonary exercise testing: physiologic principles and clinical applications. Philadelphia: WB Saunders; 1986.

Myers J, Gullestad L, Vagelos R, Do D, Bellin D, Ross H, et al. Cardiopulmonary exercise testing and prognosis in severe heart failure: 14 ml/kg/min revisited. Am Heart J. 2000;139:78-84.

Wilson JR. Exercise and the failing heart. Cardiol Clin. 1987;5:171-181.

Ware JJ, Sherbourne CD. The MOS 36-item short-form health survey(SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473-483.

Kind P. The EuroQol instrument: an index of health-related quality of life. In: Spilker B, editor. Quality of life and Pharmaco Economics in clinical trials. 2nd ed. Philadelphia: Lippincott-Raven Publishers; 1996.

Rector TS, Tschumperlin LK, Kubo SH, Bank AJ, Francis GS, Mc Donald KM, et al. Use of the living with heart failure questionnaire to ascertain patients’ perspectives on improvement in quality of life versus risk of drug induced death. J Card Fail. 1995;1:201-206.

Spertus J, Peterson E, Conard MW, Heidenreich PA, Krumholz HM, Jones P, et al. Cardiovascular outcomes research consortium. Monitoring clinical changes in patients with heart failure: a comparison of methods. Am Heart J. 2005;150:707-715.

Konstam V, Salem D, Pouleur H, Kostis J, Gorkin L, Shumaker S, et al. Baseline quality of life as a predictor of mortality and hospitalization in 5,025 patients with congestive heart failure. SOLVD Investigations. Studies of left ventricular dysfunction investigators. Am J Cardiol. 1996;78:89-105.

Soto GE, Jones P, Weintraub WS, Krumholz HM, Spertus JA. Prognostic value of health status in patients with heart failure after acute myocardial infarction. Circulation. 2004;110:546-551.

Schoen C, How SK. National scorecard on U.S. health system performance: technical report. The Commonwealth Fund; 2006.

Roe CM, Motheral BR, Teitelbaum F, Rich MW. Angiotensin converting enzyme inhibitor compliance and dosing among patients with heart failure. Am Heart J. 1999;138:818-825.

Rich MW, Gray DB, Beckham, Wittenberg C, Luther P. Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure. Am J Med. 1996;101:270-276.

Sadik A, Yousif M, McElnay JC. Pharmaceutical care of patients with heart failure. Br J Clin Pharmacol. 2005;60:183-193.

Kadish A, Mehra M. Heart failure devices: implantable cardioverter defibrillators and biventricular pacing therapy. Circulation. 2005;111:3327-3335.

Small RS. Integrating device-based monitoring into clinical practice: insights from a large heart failure clinic. Am J Cardiol. 2007;99:17-22.

Greenberg BH, Barnard DD. Contemporary diagnosis and management of heart failure. Newtown (PA): Handbooks in Health Care Company; 2005.

McNutt RA. Shared medical decision making: problems, process, progress. JAMA. 2004;292:2516-2518.

Zickmund SL, Blasiole JA, Brase V, Arnold RM. Congestive heart failure patients report conflict with their physicians. J Card Fail. 2006;12:546-553.

Califf RM, Vidaillet H, Goldman L. Advanced congestive heart failure: what do patients want. Am Heart J. 1998;135:S320-326.

Allen LA, Yager JE, Funk MJ, Levy WC, Tulsky JA, Bowers MT, et al. Discordance between patient-predicted and model-predicted life expectancy among ambulatory patients with heart failure. JAMA. 2008;229:2533-2542.

Stevenson LW, Desai AS. Selecting patients for discussion of the ICD as primary prevention for sudden death in heart failure. J Card Fail. 2006;12:407-412.

Goldenberg I, Vyas AK, Hall WJ, Moss AJ, Wang H, He H, et al. Risk stratification for primary implantation of a cardioverter-defibrillator in patients with ischemic left ventricular dysfunction. J Am Coll Cardiol. 2008;51:288-296.

Koelling TM, Johnson ML, Cody RJ, Aaronson KD. Discharge education improves clinical outcomes in patients with chronic heart failure. Circulation. 2005;111:179-285.

Levy W, Mozaffarian D, Linker DT, Sutradhar SC, Anker SD,Cropp AB, et al. The seattle heart failure model: prediction of survival in heart failure. Circulation. 2006;113:1424-1433.

ACC/AHA/HFSA Guideline for the management of heart failure. Journal of Cardiac Failure. 2022;28;4

Advance care planning; 2007.

Available:http://www.ahrq.gov/ research/endliferia/endria.htm

Krumholz HM, Phillips RS, Hamel MB, Teno JM, Bellamy P, Broste SK, et al. Resuscitation preferences among patients with severe congestive heart failure: results from the support project. Circulation. 1998;98:648-655.

Formiga F, Chivite D, Ortega C, Casas S, Ramon JM, Pujol R. End of-life preferences in elderly patients admitted for heart failure. QJM. 2004;97:803-808.

Michalsen A, Konig G, Thimme W. Preventable causative factors leading to hospital admission with decompensated heart failure. Heart. 1998;80:437-441.

Bass EB, Fortin AH 4th, Morrison G, Willis S, Mumford LM, Goroll AH. National survey of clerkship directors in internal medicine on the competencies that should be addressed in the medicine core clerkship. Am J Med. 1997;102:564-571.

Maclure M, Nguyen A, Carney G, Dormuth C, Roelants H, Ho K, et al. Measuring prescribing improvements in pragmatic trials of educational tools for general practitioners. Basic Clin Pharmacol Toxicol. 2006;98:243-252.

DeLong JF, Allman RM, Sherill RG, Schiesz N. A congestive heart failure project with measured improvements in care. Eval Health Prof. 1998;21:472-486.

Thomson O’Brien MA, Freemantle N, Oxman AD, Wolf F, Davis DA, Herrin J. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2001;(2):CD003030.

Bonow RO, Bennett S, Casey DE Jr, Ganiats TG, Hlatky MA, Konstam MA, et al. American College of Cardiology; American Heart Association Task Force on Performance Measures; Heart Failure Society of America. ACC/AHA clinical performance measures for adults with chronic heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Heart Failure Clinical Performance Measures): endorsed by the Heart Failure Society of America. Circulation 2005;112:1853-1887.

Konstam MA. Executive council of the heart failure society of America. Heart failure training: a call for an integrative, patient focused approach to an emerging cardiology subspecialty. J Am Coll Cardiol. 2004;44:1361-1362.

Donabedian A. Twenty years of research on the quality of medical care: 1964-1984. Eval Health Prof. 1985;8:243-265.

Krumholz HM, Wang Y, Mattera JA, Wang Y, Han LF, Ingber MJ, et al. An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with heart failure. Circulation. 2006;113:1693-1701.