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Originally published September 22, 2026
Last updated September 22, 2026
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There’s a great deal of variation in U.S. healthcare. Different healthcare systems with varying resources have many different providers with differing approaches to care — even within the same field, such as cardiology.
As a result of these discrepancies, many patients see heart failure specialists later than they should.
“There is a lot of variability, so there is a lot of opportunity for us to help educate the medical community and get patients here before they’re too sick,” says Raymond C. Lee, MD, a cardiac surgeon with the USC Cardiac and Vascular Institute, part of Keck Medicine of USC. At Keck Medicine, Lee serves as surgical director of the USC Advanced Heart Failure Center, as well as surgical director of USC Heart Transplant Program, part of the USC Transplant Institute.
For busy cardiologists in the community who see large numbers of patients, it can be challenging to know when to refer patients to heart failure specialists.
But heart failure doesn’t happen all at once. “Heart failure is usually a very slow decline in heart function, with slow and subtle findings,” Lee says. Typically, patients with heart failure have many revisits. During this period, maybe a year or two, physicians have an opportunity to refer their patients to heart failure specialists.
Physicians should pay close attention to common symptoms indicating their patients might need to be referred. Such symptoms include fatigue; swelling in the legs; dyspnea, or shortness of breath, especially on exertion; and orthopnea, or trouble breathing while lying flat. “Those are very telltale signs,” Lee says.
And the sooner the referral, the better. “When patients are in the office and not feeling great but don’t need to go to the hospital, that’s the best time to refer them to heart failure specialists,” he says.
Unfortunately, a timely referral doesn’t always happen, which leads to greater complexity in the patient’s condition and treatment. Many patients see heart failure specialists only when they’re in cardiogenic shock. “Once we’re in the acute inpatient setting, we’re behind the eight ball,” Lee says. “We see a lot of patients who are in cardiogenic shock, malperfused or at the end stage, so we’re rapidly trying to stabilize the patient.”
At that point, it becomes more difficult for the care team to get the patient stable enough to consider a transplant, ventricular assist device or any other procedure. And the risk of mortality increases dramatically.
Lee’s advice for referring physicians: If a patient demonstrates heart failure symptoms and doesn’t respond to medical therapy, call heart failure specialists so they can start evaluating the patient as soon as possible. “It’s never too early to send that referral,” he says.
At the USC Cardiac and Vascular Institute, specialists care for patients with a broad range of heart conditions. “Our surgeons have a very wide scope of practice, so we’re comfortable taking care of complex problems,” Lee says. “We have the ability to provide very complex care to very sick patients.”
He has found that patients often develop lasting and satisfying relationships with their healthcare providers, and not just the surgeons. “Sometimes our patients and nurses form very strong bonds that last over decades,” he says.
Also, Keck Medicine’s specialists don’t simply take over care from community physicians but work in collaboration with them, Lee notes. “We provide shared care with the referring doctors to try to catch these conditions in their earlier phase,” he says. “We keep an open dialogue with our physicians in the community.”
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