Value-based care in heart failure: a scoping review of patient outcomes and the evolving role of nursing

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Heart failure (HF) is associated with high hospitalization rates and healthcare costs, highlighting limitations of traditional fee-for-service models. Value-Based Care (VBC) emphasizes improving patient outcomes relative to healthcare expenditures. However, the role of nursing within HF-related VBC models has not been comprehensively mapped. This scoping review followed Joanna Briggs Institute methodology and PRISMA-ScR guidelines. PubMed, Scopus, and Web of Science were searched up to November 30, 2025. Studies examining VBC or payment models in adults with HF and explicitly addressing nursing roles or interventions were included. After screening 116 records and assessing 79 full texts, 20 studies were included. No formal quality appraisal was performed, consistent with scoping review methodology. Three categories of VBC models were identified: population-based, episode-based, and performance-based. Five major nursing roles emerged: Clinical Leader and Care Coordinator, Case Manager and Direct Care Provider, Educator and Patient Empowerer, Data-Literate Professional and Digital Health User, and Patient Advocate and Access Facilitator. Greater nursing involvement was associated with lower readmission and mortality rates, improved quality of life, enhanced care coordination, and potential economic benefits through reduced avoidable hospitalizations. Interprofessional collaboration and nursing leadership were key facilitators, whereas financial toxicity, inadequate payment structures, and increased workload were major barriers. Nursing represents an important component of several VBC approaches for HF, particularly through care coordination, patient education, self-management support, digital health use, and navigation of access barriers. The available evidence should be interpreted as a map of reported nursing roles and associations rather than as evidence of causal effectiveness or superiority of specific VBC models. Value-based care (VBC) provides an alternative to volume-based approaches for managing heart failure, with increasing emphasis on longitudinal and population-based care. Nurses contribute to VBC through care coordination, case management, patient education, self-management support, digital health use, and patient advocacy. Several included studies reported associations between greater nursing involvement and favorable clinical, experiential, or economic outcomes. Economic benefits were reported in several nurse-led or nurse-integrated models, although findings varied across settings and study designs. Financial toxicity, payment-model design, resource limitations, and workload may constrain implementation of nursing-integrated VBC. An analytically derived conceptual framework maps contextual factors, nursing roles and interventions, reported mechanisms or pathways, and outcomes.

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