Many heart failure patients miss out on life saving specialist care

If you have cancer, you expect to see an oncologist, but if you have heart failure you may or may not see a cardiologist. According to research published in the European Heart Journal today (Sunday), only around three out of five heart failure patients see a cardiologist at least once a year.

The study, also presented at Heart Failure Congress 2025, shows that patients who do see a cardiologist once a year are around 24% less likely to die in the following year. It also shows which patients could benefit from seeing a cardiologist once a year and which patients should be seen more often.

The research suggests that if cardiologists did see heart failure patients at least once a year, one life could be saved for every 11–16 patients seen.

The study is by a team of French researchers led by Dr. Guillaume Baudry and Professor Nicolas Girerd from the Clinical Investigation Centre of Nancy University Hospital.

In patients with heart failure, the heart is unable to normalise blood flow and pressure. Heart failure can't usually be cured, but with the right treatment, symptoms can often be controlled for many years. At the moment, depending on the patient and their condition, for example whether they have chronic or acute heart failure, they may or may not be seen by a cardiologist.

We conducted this study to see whether some simple criteria could be used to divide patients into high or lower risk categories and to assess whether an appointment with a cardiologist is linked with deaths or hospitalization in heart failure patients at the national level, based on these categories."

Dr. Guillaume Baudry, Clinical Investigation Centre of Nancy University Hospital

The study included all French patients living with heart failure in January 2020 who had been diagnosed in the previous five years – 655,919 people in total. These patients were found using French national medical administrative data. Researchers broke the group down according to whether they had been hospitalized with heart failure in the last year or the last five years, and whether or not they were taking diuretics as a treatment. Diuretics help the body eliminate excess sodium through urine, which reduces the build-up of fluid in the body.

Among all groups of patients, researchers found that around two out of every five patients did not see a cardiologist over the course of a year. Those who did see a cardiologist were less likely to die of any cause and less likely to be hospitalized with heart failure in the following year.

Taking into account the number of cardiology consultations available at a national level, the researchers created a model to show how often patients should see a cardiologist, based on recent hospitalization and diuretic use, to reduce the risk of death as much as possible.

According to the model, patients who had not recently been hospitalized and were not taking diuretics, one visit per year would be optimal to minimise the risk of death. This would reduce their risk of dying in the following year from 13% to 6.7%.

Those who had not recently be hospitalized but were taking diuretics, should be seen two to three times per year. This would reduce their risk of death from 21.3% to 11.9%.

In patients who had been hospitalized in the last five years, but not in the last year, being seen two to three times per year appears optimal. This would reduce the risk from 24.8% to 12.9%.

For patients who had been hospitalized in the last year, four appointments with a cardiologist were optimal. This reduced the risk from 34.3% to 18.2%

The researchers caution that the design of the study (a retrospective observational study) means they cannot be certain that seeing a cardiologist leads to a lower risk of death, only that the two are associated. Although they made every attempt to account for other factors, it could be that patients under the care of cardiologists have had a lower risk of dying for some other reason.

Dr Baudry said: "Although there are inherent limitations in observational research, our findings highlight the potential value of specialist follow-up, even in patients who appear clinically stable. Patients should feel encouraged to ask for a cardiology review, particularly if they have recently been in hospital or they are taking diuretics."

Professor Girerd added: "There could be many reasons why heart failure patients do not see a cardiologist, for example, we know that older people and women are less likely to see a cardiologist. We found that patients with another chronic condition, such as diabetes or a lung condition, were also less likely to see a cardiologist. These differences have been found in many countries around the world.

"Our findings suggest that referrals to cardiology could be made more systematically in heart failure care, in the same way that an oncology referral is part of routine cancer care.

"We have also found that that two very simple criteria – recent hospitalization and diuretic use – can easily stratify patient risk. These criteria don't involve any expensive tests, so can be used by anyone, in any setting, in any country. These results could help redesign health systems to reduce deaths while preserving resources."

The researchers are now planning to test their findings in an interventional clinical trial. They also hope to study the impact of seeing a cardiologist for heart failure in other countries with different healthcare systems.

In an accompanying editorial Professor Lars Lund from the Karolinska Institutet, Stockholm, Sweden said: "Since the first heart transplantation in 1967, drug discovery, technology advances, and rigorous randomised clinical trials have delivered extensive and highly effective evidence-based and guideline-directed medical therapy and other interventions for heart failure. Yet patients are not receiving and benefiting from these treatments. Consequently, outcomes in heart failure are not improving.

"…the present French study adds important evidence that for patients with heart failure, regardless of severity, access to cardiology follow-up is associated with improved use of guideline-directed medical therapy and improved outcomes. Yet, in many countries, there is a continued push to triage patients with heart failure away from cardiology and toward primary care which is often overburdened and cannot be expected to master the complexities of heart failure treatment selection and optimisation. Heart failure is common and serious, but treatable. What good is 50 years of discovery, innovation, and rigorous randomised-controlled trials delivering highly effective therapy, if this therapy is not used?"

In a second presentation at Heart Failure Congress 2025 on the same cohort, the researchers discussed sex differences in outcome and healthcare utilisation. After adjusting for demographic differences, they found that 33.8% of women did not see a cardiologist within a year while in men, the proportion was 27.9%. Women were also less likely to be prescribed RAS inhibitors, which act to lower blood pressure. Despite these differences, women had better outcomes than men in term of mortality and heart failure events.