Specialist heart failure clinics must evolve to stay relevant.

The widespread acceptance of heart-failure (HF) clinics is based on studies with poor and poorly-described care. This led to HF-clinic proliferation, often with access for a small percentage of younger, healthier and generally affluent patients. This system fails to provide the essential timely access to specialist-team consultation following hospital-discharge. Recent well-conducted randomized trials of HF-clinic care found no benefit over usual care. To provide optimal value, HF-clinics must evolve to devote resources to timely assessment/reassessment and close follow-up of selected high-risk/advanced HF patients, along with timely support of the primary-care team that will assure the bulk of routine HF care.