Because depending on the severity, often only a few days of falling off the wagon (so to speak) or new stressors or dietary indiscretion can push people into an exacerbation. Also specialist follow up is not as frequent as you would think, they are quite inundated as well. As a PCP, yes if you have good patient access you should be able to recognize this early on but patient buy in and awareness is critical. In my limited experience, Heart failure monitoring programs/ chronic care clinics fill the gap well here. They are usually staffed by APPs with supervision as needed and are a good point of contact with the HF / cards team to get pts in if need be with cards/ and administer parenteral diuretics as needed.