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Correspondence to Dr Geraint Morton, Department of Cardiology, Queen Alexandra Hospital, Portsmouth, SO6 3LY, UK; [email protected]
Learning objectives
Gain an overview of the evidence and guidelines relating to a multidisciplinary approach to heart failure care.
Understand what constitutes multidisciplinary care.
To consider how heart failure care might be organised, understanding that this will vary in different healthcare settings.
Introduction
Heart failure (HF) is a complex, relapsing, severe chronic disease. It causes multisystem dysfunction and results in a high burden of morbidity, mortality and healthcare costs. It is common, affecting ≥10% of the people aged over 70,1 and despite advances in cardiac care the incidence probably remains stable.2 In the UK, it is estimated to be the primary diagnosis in 5% of acute admissions and costs the National Health Service approximately £2 billion/year (~2% of the total budget).3 Furthermore, outcomes for those with both chronic stable disease and acute HF remain relatively poor, comparing unfavourably to many malignant conditions.4
A multidisciplinary team (MDT) approach is considered the gold standard model for the delivery of HF care. However, to shape effective multidisciplinary HF services, it is crucial to understand the relevant evidence base, the essential components of an MDT approach and how services might evolve.
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Since HF results in multisystem dysfunction, it seems intuitive to adopt an MDT approach to care, which recognises this complexity and allows various aspects of the illness to be addressed by the most appropriate healthcare professionals. The aim is to provide individualised, holistic care, which is responsive to the changing needs of patients throughout the course of the illness and seamlessly transitions primary and secondary care. In other words, it allows patients to receive the right care from the right person at the right time.
MDT care is often part of disease management programmes—a term covering a broad range of structured treatment plans and interventions for patients with chronic disease. However, while these programmes are frequently delivered by an MDT, this is not always the case and therefore the terms are not interchangeable.
MDT care is strongly recommended by the National Institute for Health and Care Excellence (NICE),3 the European Society of Cardiology (ESC) (class 1A recommendation)1 and the American College of Cardiology...