Timelines of the first heart failure consultation and outcomes in HFrEF: establishing a temporal threshold for follow-up

Introduction

Timely follow-up after hospital discharge or initial diagnosis is recommended to reduce adverse outcomes in HFrEF. However, objective evidence defining the maximum acceptable waiting time for the first consultation is lacking, and the prognostic impact of delayed access to specialized follow-up in real-life practice remains unclear.

Aim

To evaluate whether waiting time until the first consultation predicts the occurrence of HF events (hospitalization or death) in patients with HFrEF and to explore whether a temporal threshold could be identified beyond which prognosis significantly worsens.

Methods

A retrospective cohort study of HFrEF patients followed at a tertiary hospital’s outpatient HF clinic was conducted. Baseline clinical, laboratory, and echocardiographic data were collected. Patients were followed for 3 years for HF events. Mean waiting time for the first consultation was compared between patients with and without events. A ROC analysis identified the optimal waiting-time threshold, which informed subsequent Kaplan–Meier and Cox regression analyses, based on the identified threshold.

Results

A total of 200 HFrEF patients were included (mean age 65.1 ± 14.6 years; LVEF 27.5 ± 8.2%). Most were in NYHA class II (46.5%). Ischemic etiology was the most common (47.5%), followed by dilated cardiomyopathy (35.5%). Mean waiting time for the first consultation was 59.9 ± 63 days.

During the 3-year follow-up period, 26 patients (13%) experienced an HF event. Patients with events had a significantly longer waiting time compared with those without events (97.3 ± 81.1 vs. 54.6 ± 58.2 days; mean difference 42.7 days; 95% CI –68.3 to –17.2; p=0.001). ROC curve analysis demonstrated meaningful discrimination and identified 60 days as the optimal threshold to predict events. Kaplan–Meier curves showed a significantly higher cumulative incidence of HF events among patients seen ≥60 days after referral (log-rank p<0.001). Cox regression confirmed that waiting ≥60 days for a first consultation was strongly associated with an increased risk of HF events (HR 5.73; 95% CI 2.41–13.65; p<0.001).

Conclusion

Delayed access to the first HF consultation is a strong predictor of mortality or hospitalization in patients with HFrEF. A waiting time ≥60 days identifies patients at higher risk, suggesting that earlier follow-up may be clinically meaningful. These findings support the need for structured pathways ensuring timely post-diagnosis or post-discharge evaluation.For image description, please refer to the figure legend and surrounding text.