Heart failure affects 6 million people in the U.S., and although they represent just over 2 percent of the total population, heart failure is the number one cause for hospitalization for people over 65. While treatments are helping people live longer, the overall prevalence of heart failure has increased along with the incidence of hospital readmissions and mortality.

Since 2014, the Cardiovascular Clinical Program team has focused their efforts on reducing the incidence of heart failure and improving outcomes for high risk patients, including reducing hospital readmissions and mortality, through the Heart Failure Pathway for High Risk Patients. McKay-Dee Hospital piloted the pathway in 2014, and their weekly collaboration and feedback helped shape and ready the program for enterprise-wide implementation. Five Intermountain hospitals began using the pathway in 2015, the remaining 17 in 2016.

The Heart Failure Pathway is the structure around a comprehensive set of processes and decisions, developed by our clinicians, to treat patients at risk for heart failure. Here’s how it works: Multidisciplinary teams of doctors, case managers, nurses, dietitians, and pharmacists review a home-grown and validated daily report to accurately identify patients who are at high risk for heart failure, hospital readmission, and mortality. This information helps the teams intervene in a timelier manner and leads to improved outcomes. The teams then deploy a set of best-practice processes and decisions to treat patients according to their specific needs in the continuum of care.

One overarching body guides the work and measures the progress of the Heart Failure Pathway, but the bulk of the work is accomplished by the teams actually rendering the care using the tools and resources developed by the Clinical Program. And because the work is coordinated throughout all of Intermountain, our patients at high risk for heart failure receive the same high standard of care at every Intermountain hospital. “We’re successful because of our interdisciplinary approach,” said Colleen Roberts, the program’s Operations Director. “Everyone is at the table and involved from the beginning.”

McKay-Dee Pilot Program

In 2014 when McKay-Dee Hospital piloted the pathway, mortality rates for patients participating in the pilot were 7% compared to 19% for patients not participating.

The percent of patients who were able to return home after hospital discharge and continue care with homecare services as opposed to going to a skilled nursing facility was 34% for those in the pilot compared to 19% for those not in the pilot.

Expanding Our Resources

Our Cardiovascular Clinical Program is working hand-in-hand with the Primary Care Clinical Program to identify risk factors like high blood pressure and lipid levels, so the work begins before our patients enter our hospitals and doesn’t end when they leave our hospitals. In the near future, we’ll be expanding the resources available for our patients by connecting them to community support groups where they will be able to speak with and learn from others who are living with the same diagnosis and dealing with the same challenges.

Stages of Heart Failure


Heart Failure Prevention - Stage A

Patient is at high risk for heart failure but has no structural heart disease or symptoms of heart failure.

Examples: Patients with hypertension, atherosclerotic disease, diabetes mellitus, obesity, metabolic syndrome

Goals: Heart-healthy lifestyle, prevent coronary disease


Stable Heart Failure - Stage B

Patient has structural heart disease but no signs or symptoms of heart failure.

Examples: Patients with previous heart attack; changes in heart’s size, shape, and physiology; asymptomatic valvular disease

Goals: Prevent further disease


Unstable Heart Failure - Stage C

Patient has structural heart disease with prior or current symptoms of heart failure.

Examples: Patients with known structural heart disease, heart failure signs/symptoms

Goals: Control symptoms, prevent hospitalization, mortality


Advanced Heart Failure - Stage D

Patient has structural heart disease with marked symptoms of heart failure and doesn’t respond to routine medical therapies.

Examples: Patients with marked heart failure symptoms, even at rest; frequent hospitalizations due to heart failure

Goals: Control symptoms, reduce hospital re-admissions, establish end-life-goals