Table 41: Recommended frequency of follow-up for patients with HF, according to risk
Risk group	Features defining risk of group	Suggested frequency of follow-up
Lower risk	NYHA class I or II No hospitalizations in past year No recent changes in medications Receiving optimal medical/device HF therapies	At least yearly. In certain cases might consider discharge of patient from HF clinic to specialist office (in addition to primary care)
Intermediate	No clear features of high or low risk	1-6 months
Higher risk	NYHA IIIb or IV symptoms Frequent symptomatic hypotension More than 1 HF admission (or need for outpatient intravenous therapy) in past year Recent HF hospitalization especially in past month Increasing creatinine level, especially GFR < 30 mL/min Nonadherence to therapy for any reason During titration of HF medications (ACEi/BB/ARB/MRA) New-onset HF Complication of HF therapy Need to downtitrate or discontinue BB or ACEi/ARB Concomitant and active illness (eg, high-grade angina, severe COPD, frailty) Frequent ICD firings	1-2 visits per month. In some cases might be weekly assessments or even more frequent—especially if patient willing to undergo multiple visits to potentially avoid a hospitalization

Many of these visits might be performed by telehealth or with allied health professionals supported in a multidisciplinary environment. The exact composition will vary according to local resources, personnel, and practice standards.

ACEi, angiotensin-converting enzyme inhibitor;
ARB, angiotensin receptor blocker;
BB, β-blocker;
COPD, chronic obstructive pulmonary disease;
GFR, glomerular filtration rate;
HF, heart failure;
ICD, implantable converter defibrillator;
MRA, mineralocorticoid receptor antagonist;
NYHA, New York Heart Association.