In the realm of cardiovascular medicine, heart failure remains a formidable challenge, affecting millions globally with a devastating impact on survival and quality of life. Despite advances in treatment, the management of heart failure patients varies considerably, particularly regarding specialist follow-up care. A landmark study published recently in the European Heart Journal and unveiled at Heart Failure Congress 2025 sheds illuminating light on the critical role cardiology consultations play in improving outcomes for heart failure patients.
Heart failure is characterized by the heart’s impaired ability to maintain adequate blood flow and pressure, a chronic condition that typically lacks a definitive cure but can be managed effectively with appropriate therapies. The study, spearheaded by French investigators led by Dr. Guillaume Baudry and Professor Nicolas Girerd from Nancy University Hospital, delves into the patterns of cardiologist engagement and their association with patient survival across an unprecedented nationwide cohort exceeding 650,000 individuals diagnosed within five years prior to January 2020.
Utilizing comprehensive French national medical administrative databases, the investigators stratified heart failure patients by recent hospitalization history and diuretic therapy usage—two clinically expedient markers of disease severity and fluid overload. The analytical framework was designed to uncover whether cardiologist follow-up frequency impacted all-cause mortality and hospital readmission rates within a subsequent year, and to pinpoint optimal consultation intervals tailored to risk profiles.
The stark findings reveal that approximately 40% of heart failure patients nationwide do not receive any cardiologist consultation within a year, a sobering insight given that survivors who had at least yearly cardiology follow-up exhibited a 24% reduction in mortality risk. This inverse relationship between specialist care and death reinforces the clinical imperative for routine cardiology involvement, positioning it as a potentially life-saving intervention rather than a discretionary referral.
Crucially, the study presents a nuanced, risk-adapted model that recommends differentiated follow-up frequencies. Patients without recent hospitalization and not receiving diuretics—a subgroup with relatively stable hemodynamics—benefited optimally from a single cardiologist visit annually, halving their one-year mortality risk from 13% to 6.7%. This suggests that even “stable” patients derive substantial survival advantage from specialist surveillance.
Conversely, those using diuretics without recent hospitalization—indicative of ongoing volume management needs—fared best with two to three cardiology appointments per year, reducing mortality from 21.3% to 11.9%. This increased frequency likely facilitates timely therapy adjustment responsive to evolving clinical status. Additionally, patients with hospitalizations in the preceding five years but not the last year similarly required biannual to triannual follow-up to halve their risk from 24.8% to 12.9%.
For the highest risk group—those hospitalized within the past year—the data underscored the necessity of more intensive scrutiny, with quarterly cardiologist consultations lowering mortality from an alarming 34.3% to 18.2%. These findings articulate a clear directive that recent acute decompensation predicates a more aggressive follow-up schedule to mitigate fatal outcomes.
Despite the compelling associations demonstrated, the research team prudently acknowledges inherent limitations of retrospective observational design. While cardiologist involvement correlates robustly with improved survival and fewer hospitalizations, causality cannot be firmly established. Confounding variables or unmeasured factors could influence these relationships; for example, patients under cardiology care may inherently possess better overall access to healthcare resources or adherence to guideline-directed medical therapies.
Nevertheless, the investigators emphasize the practical utility of the two simple clinical criteria—recent hospitalization and diuretic use—as scalable tools to stratify patient risk without reliance on costly or complex diagnostics. This pragmatic approach holds promise for widespread application, particularly in resource-limited settings where optimizing specialty referrals could yield pronounced public health benefits.
The study also highlights concerning disparities in cardiologist access, noting that women and older patients, as well as those with concurrent chronic conditions like diabetes and pulmonary diseases, are less frequently engaged by cardiology services. Such inequities mirror global patterns and suggest systemic barriers that must be addressed to ensure equitable care delivery.
In an accompanying editorial, Professor Lars Lund of the Karolinska Institutet contextualized these findings within a broader clinical conundrum: Despite decades of scientific breakthroughs heralding effective heart failure therapies, real-world implementation lag persists. He underscored the paradox of patients being diverted away from cardiology follow-up towards overtaxed primary care providers, often unable to navigate the intricacies of advanced heart failure management.
Professor Lund’s commentary reinforces the notion that specialty follow-up is not merely an administrative luxury but an essential pillar of achieving optimal outcomes. The study invigorates calls for revising care pathways to embed systematic cardiology referral, akin to oncology’s standard referral practices, thereby closing the gap between evidence and practice.
Future directions, as outlined by the French research team, include prospective interventional trials to rigorously test the causative impact of varying cardiology follow-up intensities and exploration of cardiologist engagement effects across diverse international healthcare systems. Such studies will be pivotal in refining guidelines and influencing health policy worldwide.
Further emphasizing the complexity of heart failure management, subsequent analyses from the same cohort unveiled sex-related disparities in healthcare utilization and outcomes. Women were notably less likely to be prescribed RAS inhibitors—cornerstone medications that modulate blood pressure and improve cardiovascular prognosis—yet paradoxically demonstrated better survival and fewer heart failure events than men. These nuanced insights beckon further research to unravel biological and sociocultural factors underpinning sex differences in heart failure trajectories.
In summary, this comprehensive nationwide cohort study presents compelling evidence that cardiologist involvement confers substantial mortality and morbidity benefits for heart failure patients, with a clear gradient of follow-up intensity tailored to recent clinical events and therapeutic markers. The findings challenge healthcare systems to adopt more systematic referral algorithms and reduce present disparities in specialist care access, heralding a new paradigm emphasizing targeted, risk-adapted specialist engagement as cornerstone of heart failure management.
Subject of Research: People
Article Title: Cardiologist follow-up and improved outcomes of heart failure: a French nationwide cohort
News Publication Date: 18-May-2025
Web References:
10.1093/eurheartj/ehaf218
References:
- Baudry G, Girerd N, et al. Cardiologist follow-up and improved outcomes of heart failure: a French nationwide cohort. European Heart Journal 2025. DOI: 10.1093/eurheartj/ehaf218.
- Editorial by Lars Lund, Karolinska Institutet, Stockholm, Sweden, European Heart Journal 2025.
- Heart Failure Congress 2025 presentations on the same cohort.
Keywords: Heart failure, Heart disease, Cardiovascular disorders, Cardiology, Mortality rates
