**1. Introduction**

Heart failure (HF) is a condition with high mortality due to decreased cardiac function leading to poor perfusion, exacerbated during high metabolic states. It is a growing pandemic expected to rise by almost 30%, expanding its reach from 6.2 million to 8 million people by 2030 in the US and many more worldwide [1–3]. It carries significant morbidity and dramatically limits patients' quality of life. The morbidity is costly, leading to high expenditures of 30.7 billion dollars annually, which is also projected to double by 2030 [4, 5]. The symptoms are debilitating as the disease progresses towards its end stages of advanced heart failure (AdHF) even despite maximally tolerated guideline directed medical therapy. At this stage in the disease process, medical therapy is inadequate and treatment must be advanced to more invasive means [6, 7]. The only viable options are orthotopic heart transplant or durable mechanical support in the form of a left ventricular assist device (LVAD). As the therapy advances, the treatment team must adapt to a multidisciplinary cohort incorporating a multitude of care providers from varying backgrounds [8–10].

Few places have the resources capable of staffing such a diversity of providers, which comes at great expense, therefore traditionally limiting care to large academic centers. Patients that do not live near these centers face geographic barriers to care coordination and are prohibited from otherwise appropriate life prolonging care. The new shared care model allows for device implantation at a large center with the subsequent transfer of follow up care to a local heart failure program capable of managing LVAD recipients. This concept allows for greater access and thereby increases effective eligibility for advanced therapies. It also improves patient adherence to the rigorous home care regimens that LVADs require. Improved access and adherence ultimately improves patient outcomes and reduces their financial burden [11].
