Practices of Referring Patients to Advanced Heart Failure Centers
Section snippets
Methods
We performed a retrospective review of patients referred for evaluation for AHF therapies (ie, LVAD and/or OHT) at 9 AHF centers across the United States. Centers provided data concerning their most recent 50--100 completed evaluations prior to July 1, 2018. Eligible patients were adults (>18 years) with AHF who were referred and subsequently completed evaluation for AHF therapies. Participating sites included California Pacific Medical Center (CA), Cleveland Clinic (OH), MedStar Washington
Results
A total of 515 patient referrals were collected across 9 sites. The population was predominantly male (73.4%) and Caucasian (55.7%), and the median age was 58 years. The most common causes of HF were nonischemic (55.9%) and ischemic (33.2%) cardiomyopathies, with other causes constituting small proportions of the total population (Table 1). Patients were advanced in their disease states at the time of referral, with 51.5% having an LVEF <20% and 74.5% dependent on inotropic support or temporary
Discussion
Our analysis is the first in the era of contemporary HF and MCS therapies to examine advanced HF referral patterns across the United States by pooling data from 9 advanced HF therapies programs. Our participating programs represent a broad distribution of size, geographic location and range in annual volume from 30 to 100 VADs and 20–80 heart transplants. This multicenter study has several important findings that help to enhance understanding of this topic.
In this cohort, a large percentage of
Conclusions
Our findings indicate that patients referred for AHF therapies tend to be male and advanced in the disease state and are often declined because of psychosocial factors. Solutions may include improved identification of AHF in females, earlier referral to AHF teams to allow for timely evaluation of AHF therapies, and addressing psychosocial concern issues before they become an obstacle to effective therapeutic decision making. These findings highlight the need for continual education and specific
Bullet Points
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Understanding how and why heart failure patients are referred to advanced heart failure centers is an important aspect of ensuring access to these lifesaving therapies.
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Recognize many patients with heart failure continue to be referred late in their disease, limiting their therapeutic options. Educational opportunities to promote earlier referral remain important to ensure access to therapeutics when appropriate.
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Patients are often cited as unable to be offered advanced therapies due to
Lay Summary
Patients with heart failure are increasing in number and even in its most advanced state have access to lifesaving medical and surgical treatments that can increase survival and quality of life. Access to these advanced therapies such as heart transplantation and mechanical circulatory support requires timely referral to centers providing these treatments. Our study examines how and why patients are referred to these centers. We found that many patients are referred late and are too sick to
Authors’ Disclosures
JJH has received research grants and has served as a speaker and consultant for Abbott Laboratories; MZT has received speaker honoraria and consulting fees for Abiomed and Abbott Laboratories; FS has received consulting fees and research support from Pfizer, consulting fees and research support from Alnylam, consulting fees from Eidos, consulting fees from Akcea, speaker honoraria and research support from Abbott Laboratories; AR has received speaker honoraria from Abbott Laboratories and
Sources of Funding
None
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2022, American Journal of CardiologyCitation Excerpt :Scientific advancements in both medical and surgical therapies, such as left ventricular assist devices (LVADs) and heart transplantation (HT), dramatically improve clinical outcomes in patients with advanced HF.3 Despite these advances, sex-based, racial-based, and ethnic-based disparities in HF care exist,4–9 with often complex and multifactorial reasons underpinning these discrepant outcomes.10 Black and Hispanic patients have the highest burden of HF and worse clinical outcomes than White patients,2 and racial and ethnic minorities often undergo advanced therapies in states of greater illness severity and acuity.11,12
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