Comprehensive, Multidisciplinary Care for Complex Cardiac Disease

Advanced heart failure care has entered a new era defined by rapid therapeutic expansion and increasing clinical complexity. Patients are living longer, new pharmacologic and device-based therapies are reshaping prognosis, and once-fatal diagnoses are now managed with durable strategies.

However, with new medications comes an increased medication burden for patients. Quadruple therapy - including SGLT2 inhibitors, beta-blockers, MRAs, and ARNIs - has become a cornerstone of postoperative therapy, with the goal of reducing morbidity and mortality after hospital discharge. The sheer number of pills required for this therapy, as well as the need for increased clinician oversight, substantially increases the time and resources invested in care.

Notably, this progress has also introduced difficult decision-making, heavier medication burdens, and the need for highly coordinated subspecialty care. According to Manreet Kanwar, MD, a professor of medicine at the University of Chicago Medicine and director of the Heart Failure and Pulmonary Hypertension program, delivering optimal outcomes today requires more than access to advanced treatments. It demands an integrated system built specifically to manage the sickest patients.

Kanwar explains that the heart failure program at UChicago Medicine has evolved to meet that challenge, featuring a team of 12 dedicated heart failure physicians who treat patients across the full spectrum of disease, from early-stage heart failure to those requiring mechanical circulatory support or heart transplantation. She emphasizes that a major differentiator of the program is its concentration of advanced heart failure expertise, particularly for patients who have failed standard medical therapy and present in critical condition.

Many of these individuals require evaluation for left ventricular assist devices (LVADs), temporary mechanical support, or transplant. She notes that careful patient selection, multidisciplinary review, and timely escalation of care are essential for achieving favorable outcomes.

Kanwar also points to pulmonary hypertension as a growing focus. Under cardiology leadership, the relaunched program provides comprehensive inpatient and outpatient management.

“This is a very unique patient population, in some ways similar to heart failure, and in some ways not necessarily, because these patients almost always have problems or issues with the right side of the heart, unlike the traditional heart failure, where they have issues with the left side of the heart,” she said. “We see these patients in our clinic, we start them on medical therapy, we work closely with our pulmonary as well as lung transplantation colleagues, because many of these patients require those kinds of therapies.”

One of the most transformative areas, according to Kanwar, has been cardiac amyloidosis. Once associated with limited treatment options and poor survival, the condition now represents a rapidly advancing field. She describes how structured diagnostic pathways, subtype-specific management, and access to multiple clinical trials, particularly those targeting transthyretin, have changed the outlook for patients. The program now follows hundreds of individuals with cardiac amyloid, reflecting both increased awareness and improved detection.

Pharmacologic innovation has similarly reshaped the broader heart failure landscape. Kanwar explains that contemporary guideline-directed medical therapies reduce hospitalizations and prolong survival across multiple heart failure subtypes. However, she acknowledges that these benefits often come with increased pill burden, especially in patients with diabetes, kidney disease, and hypertension. Balancing medication complexity with measurable outcome gains is an ongoing challenge requiring individualized assessment and shared decision-making.

Beyond clinical interventions, Kanwar underscores the importance of psychosocial support. Recurrent hospitalizations and progressive symptoms can take a profound emotional toll. Integrated social work and behavioral health resources, she notes, are essential components of comprehensive heart failure care.

“[Heart failure] is a disease that often does not come in isolation. These patients have, for example, diabetes, high blood pressure, they're more likely to have other issues like kidney failure, sometimes stroke and anemia,” she explained. “These patients then end up back in the hospital often, and this interplays into the significant burden of depression… We try to support them, of course, through medical options, but also ably supported by our colleagues, including in social work and psychology, and also sometimes we refer them to psychiatry. We may not be best trained to suit those needs, but we recognize them and try to connect the dots for these patients.”

Additionally, psychosocial support has the capacity to increase adherence to practical preventive factors, such as the well-known Life’s Essential 8. According to data from the American Heart Association (AHA), factors such as smoking, obesity, physical activity, nutrition, and sleep contribute so strongly to cardiovascular disease prevention that adherence to the LE8 suggestions could prevent up to 40% of cardiovascular deaths annually.

As therapies grow more sophisticated, Kanwar believes the future of advanced heart failure depends on systems designed to manage complexity, clinically, technologically, and emotionally, while keeping patients at the center of every decision.

Editors’ Note: Kanwar reports relevant disclosures with Abiomed and Abbott.

References

1. Greene SJ, Xu H, Chiswell K, et al. One-year outcomes in patients hospitalized for heart failure with reduced ejection fraction prescribed quadruple medical therapy at discharge. JAMA Cardiology. Published online January 28, 2026. doi:10.1001/jamacardio.2025.5339

2. Palaniappan LP, Allen NB, Almarzooq ZI, et al. 2026 heart disease and stroke statistics: A report of US and Global Data from the American Heart Association. Circulation. Published online January 21, 2026. doi:10.1161/cir.0000000000001412