TY - JOUR
T1 - Practices of Referring Patients to Advanced Heart Failure Centers
AU - IDEAL-HF investigators
AU - Herr, Jared J.
AU - Ravichandran, Ashwin
AU - Sheikh, Farooq H.
AU - Lala, Anuradha
AU - Chien, Christopher V.
AU - Hsiao, Stephanie
AU - Srivastava, Ajay
AU - Pedrotty, Dawn
AU - Nowaczyk, Jennifer
AU - Tompkins, Shannon
AU - Ahmed, Sara
AU - Xiang, Fei
AU - Forest, Stephen
AU - Tong, Michael Z.
AU - D'souza, Benjamin
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/11
Y1 - 2021/11
N2 - Background: Therapies for advanced heart failure (AHF) improve the likelihood of survival in a growing population of patients with stage D heart failure (HF). Successful implementation of these therapies is dependent upon timely and appropriate referrals to AHF centers. Methods: We performed a retrospective analysis of patients referred to 9 AHF centers for evaluation for AHF therapies. Patients’ demographics, referring providers’ characteristics, referral circumstances, and evaluation outcomes were collected. Results: The majority of referrals (n = 515) were male (73.4%), and a majority of those were in the advanced state of the disease: very low left ventricular ejection fraction (<20% in 51.5%); 59.4% inpatient; and high risk Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles (74.5% profile 1–3). HF cardiologists (49.1%) were the most common originating referral source; the least common (4.9%) were electrophysiologists. Common clinical triggers for referral included worsening HF (30.0%), inotrope dependence (19.6%), hospitalization (19.4%), and cardiogenic shock (17.8%). Most commonly, AHF therapies were not offered because patients were too sick (38.0%–45.1%) or for psychosocial reasons (20.3%–28.6%). Compared to non-HF cardiologists, patients referred by HF cardiologists were offered an AHF therapy more often (66.8% vs 58.4%, P = 0.0489). Of those not offered any AHF therapy, 28.4% received home inotropic therapy, and 14.5% were referred to hospice. Conclusions: In this multicenter review of AHF referrals, HF cardiologists referred the most patients despite being a relatively small proportion of the overall clinician population. Late referral was prevalent in this high-risk patient population and correlates with worsened outcomes, suggesting a significant need for broad clinician education regarding the benefits, triggers and appropriate timing of referral to AHF centers for optimal patient outcomes.
AB - Background: Therapies for advanced heart failure (AHF) improve the likelihood of survival in a growing population of patients with stage D heart failure (HF). Successful implementation of these therapies is dependent upon timely and appropriate referrals to AHF centers. Methods: We performed a retrospective analysis of patients referred to 9 AHF centers for evaluation for AHF therapies. Patients’ demographics, referring providers’ characteristics, referral circumstances, and evaluation outcomes were collected. Results: The majority of referrals (n = 515) were male (73.4%), and a majority of those were in the advanced state of the disease: very low left ventricular ejection fraction (<20% in 51.5%); 59.4% inpatient; and high risk Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles (74.5% profile 1–3). HF cardiologists (49.1%) were the most common originating referral source; the least common (4.9%) were electrophysiologists. Common clinical triggers for referral included worsening HF (30.0%), inotrope dependence (19.6%), hospitalization (19.4%), and cardiogenic shock (17.8%). Most commonly, AHF therapies were not offered because patients were too sick (38.0%–45.1%) or for psychosocial reasons (20.3%–28.6%). Compared to non-HF cardiologists, patients referred by HF cardiologists were offered an AHF therapy more often (66.8% vs 58.4%, P = 0.0489). Of those not offered any AHF therapy, 28.4% received home inotropic therapy, and 14.5% were referred to hospice. Conclusions: In this multicenter review of AHF referrals, HF cardiologists referred the most patients despite being a relatively small proportion of the overall clinician population. Late referral was prevalent in this high-risk patient population and correlates with worsened outcomes, suggesting a significant need for broad clinician education regarding the benefits, triggers and appropriate timing of referral to AHF centers for optimal patient outcomes.
KW - Cardiomyopathy
KW - Heart failure
KW - Transplantation
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U2 - 10.1016/j.cardfail.2021.05.024
DO - 10.1016/j.cardfail.2021.05.024
M3 - Article
C2 - 34146684
AN - SCOPUS:85111029232
SN - 1071-9164
VL - 27
SP - 1251
EP - 1259
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 11
ER -