Multidisciplinary Care and Addressing Pill Burden in HF, With Bernard Kadosh, MD, and Eiran Gorodeski, MD, MPH

In recent years, heart failure (HF) care has become increasingly multidisciplinary, as clinicians from the myriad specialties that affect it come together to address common issues faced by patients, including comorbidities, pill burden, and outcomes.

Several clinical guidelines in recent years have emphasized the importance of multidisciplinary teamwork in the prevention and treatment of HF. In addition to specialists and HF nurses, recommendations encourage primary care physicians to enter the fold as well, making care more accessible in locations which may be limited in their access to specialization.1

“We need to demystify heart failure treatment,” Bernard Kadosh, MD, medical director of the ventricular assist device and cardiogenic shock programs at NYU Langone Health, told HCPLive in an exclusive interview. “You don’t really need an advanced heart failure physician to treat most patients with heart failure. We’re here to lift up the patient when they get to the stage where they may need a little bit more help than what GDMT is able to provide for them. Most of the workforce that will be touching a heart failure patient will probably be internists, primary care physicians, and general cardiologists. It’s incumbent upon us as specialists to make care easier and more accessible.”

Multidisciplinary care can also allow easier access to HF specialists, as primary care providers and other non-specialty clinicians and nurses can conduct non-pharmacological treatment methods. Additionally, multidisciplinary teams can be adapted to several different service models, allowing clinics to address patient concerns at any level.1

Increasingly high on the list of concerns in HF treatment is pill burden. In recent years, the manifold prescription medications for various treatments, coupled with a rising distrust in the medical industry at large, have fueled the burden of taking multiple HF drugs among patients.2

Recent studies have highlighted the degree to which pill burden affects patients with HF, determining significant variance depending on clinical and psychosocial factors. Additionally, the study discovered that higher burden of treatment increases the risk of adverse health outcomes as a result of lower adherence.2

Pill burden is often attributed to the sheer number of crucial HF therapies, including the 4 main pillars of ARNI, beta-blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors. In combination, these drugs provide optimal prevention and maintenance of HF – however, all 4 pills are often not taken in conjunction. This naturally increases a patient’s risk of hospitalization, complications, and eventually mortality.2

“Patients are willing to take all types of supplements and vitamins, but when you tell them they’ll need to be on 4 medications for heart failure, their eyes are wide open and they’re shocked,” Eiran Gorodeski, MD, MPH, professor of medicine and section head of the section of advanced heart failure at Case Western Reserve University School of Medicine, as well as director of the advanced heart failure and transplant center at University Hospitals, told HCPLive. “First of all, we need to acknowledge the pill burden – to ignore the pill burden will fuel distrust. And then, I think the next step is to explain why those therapies are lifesaving. They reduce the risk of getting hospitalized, they may help the structure of the heart improve, and they improve survival.”

Editors’ Note: Kadosh and Gorodeski report no relevant disclosures.

References

1. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726. doi:10.1093/eurheartj/ehab368

2. Smith JL, Killian JM, Shippee N, et al. Burden of treatment in patients with heart failure. Journal of the American Heart Association. 2025;14(10). doi:10.1161/jaha.124.039695