There has been a notable increase over the last decade in the volume of outpatient, inpatient, and advanced therapy needs associated with patients with heart failure (HF), according to a new report from ACC's Heart Failure and Transplant Member Section Council published April 9 in JACC: Heart Failure. As a result of this growth, as well as other major changes in the field of advanced HF and transplant cardiology, workforce needs are not being met.

The report was based on the results of an online survey sent to 211 hospitals, private cardiovascular groups and university hospital systems or health centers in the U.S. that provide advanced HF services, including left ventricular assist device (LVAD) implantation and heart transplantation. Of these, 43 institutions from 21 states responded.

Overall, the survey found that the average number of unique patients seen annually at advanced HF centers was approximately 2,424, up from 804 when a similar survey was conducted in 2015. Researchers also noted increases in the reported volume of patients undergoing heart transplantation or receiving mechanical circulatory support (MCS).

Specifically, heart transplantation volume increased from 29.1 and 21.4 in 2018 at universities and private institutions, respectively, to 32.8 and 22.6 in 2020. Similarly, MCS volume increased from 56.9 to 71.7 at universities and 57.6 to 79 at private programs during this same period. The volume of LVADs did decrease slightly in both university and private settings. More than 50% of institutions also said they had outpatient diuretic intravenous infusion available, which requires its own resources and specialized staffing.

Remote monitoring was also a focus of the report, with more than 60% of responding institutions saying they use telephone or implantable electronic devices, to monitor symptoms, daily weight, blood pressure, heart rate variability, lead impedance, etc. More than 90% of institutions also said they use implantable hemodynamic monitors, with 15% having more than 100 patients under active hemodynamic monitoring and 33% following 21-50 patients.

The report also shed light on staffing trends at advanced HF institutions. While the report authors noted that direct comparisons cannot be made, they highlighted an increase in the number of advanced HF physicians per program from 2.65 in 2009 to 6.65. The number of advanced practice providers (APPs) and coordinators also increased during this period, going from 2.2 to 5.4 and from 2.6 to 7.7, respectively.

"These numbers reflect the growing integration and inclusion of diverse groups of practitioners into the multidisciplinary teams of advanced HF programs," said the authors.

In addition to physicians and APPs, responding institutions said they also employed data and quality managers, and most had pharmacists, social workers, psychologists, nutritionists, financial consultants, exercise physiologists, inventory managers, and research coordinators on staff. Additionally, more than 70% of survey respondents said they hired other personnel on an "as-needed" basis and some programs also had dedicated schedulers, phlebotomists, administrative assistants and other staff members.

"As new advanced HF programs are formed and existing ones aim to expand, HF programs have an ever-expanding number of roles, including remote monitoring, serving as the primary consultants for critically ill patients, and other functions," write Maya E. Guglin, MD, FACC, et al. "This survey may help HF programs and administrators better contextualize the increased complexity of HF patient care and better predict and meet the resultant increased staffing requirement."