Perspective:

The growing prevalence of HF and the fiscal burden of recurrent HF readmissions have led to increased scrutiny placed on physicians providing HF care. Recently, ‘pay for performance’ measures have been adopted by many agencies and third party payers in an effort to reduce HF costs through perceived improvements in evidence-based care.

Limitations of a population survey aside, this study highlights the ‘gerbil on a wheel’ feeling many HF physicians face when caring for these complex patients. HF patient volumes are vast and the number of clinicians trained in Advanced Heart Failure and Cardiac Transplant care annually is scant. Both the number of Advance Heart Failure fellowships and the number of individuals interested in entering this field are few because incentives are low. In the past 5 years, few interventions have been shown scientifically to substantially improve HF outcomes, and the number one cause for readmission in many studies is patient nonadherence. Unfortunately, studies on complex patient telemanagement programs meant to improve patient adherence and reduce readmissions have been inconsistent in demonstrating benefit.

HF is only going to increase in burden. Studies are needed to identify the best and most cost-effective means of providing long-term management for these patients. Finally, incentives to attract practitioners into the field of advanced HF are warranted.