Practices of Referring Patients to Advanced Heart Failure Centers.

MedStar author(s):
Citation: Journal of Cardiac Failure. 27(11):1251-1259, 2021 11.PMID: 34146684Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Heart Failure | Female | Heart Failure/di [Diagnosis] | Heart Failure/ep [Epidemiology] | Heart Failure/th [Therapy] | Humans | Male | Retrospective Studies | Stroke Volume | Ventricular Function, LeftYear: 2021Local holdings: Available online from MWHC library: 1995 - presentISSN:
  • 1071-9164
Name of journal: Journal of cardiac failureAbstract: BACKGROUND: AHF therapies improve survival in a growing population of Stage D HF patients. Successful implementation of these therapies is dependent upon timely and appropriate referrals to AHF centers.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. Copyright (c) 2021. Published by Elsevier Inc.METHODS: We performed a retrospective analysis of patients referred to 9 AHF centers for evaluation for AHF therapies. Patient demographics, referring provider characteristics, referral circumstances, and evaluation outcomes were collected.RESULTS: Majority of referrals (N=515) were male (73.4%), with a majority of those in the advanced disease state: very low LVEF <20% in 51.5%, 59.4% inpatient, and high risk INTERMACS profiles (74.5% profile 1-3). HF cardiologists (49.1%) were the most common originating referral source; least common (4.9%) were electrophysiologists. Common clinical triggers for referral included worsening heart failure (30.0%), inotrope dependence (19.6%), hospitalization (19.4%) and cardiogenic shock (17.8%). Most commonly, AHF therapies were not offered due to patients being too sick (38.0 - 45.1%) or 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.All authors: Ahmed S, Chien CV, D'Souza B, Forest S, Herr JJ, Hsiao S, IDEAL-HF investigators, Lala A, Nowaczyk J, Pedrotty D, Ravichandran A, Sheikh FH, Srivastava A, Tompkins S, Tong MZ, Xiang FOriginally published: Journal of Cardiac Failure. 2021 Jun 16Fiscal year: FY2022Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-07-19
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 34146684 Available 34146684

Available online from MWHC library: 1995 - present

BACKGROUND: AHF therapies improve survival in a growing population of Stage D HF patients. Successful implementation of these therapies is dependent upon timely and appropriate referrals to AHF centers.

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. Copyright (c) 2021. Published by Elsevier Inc.

METHODS: We performed a retrospective analysis of patients referred to 9 AHF centers for evaluation for AHF therapies. Patient demographics, referring provider characteristics, referral circumstances, and evaluation outcomes were collected.

RESULTS: Majority of referrals (N=515) were male (73.4%), with a majority of those in the advanced disease state: very low LVEF <20% in 51.5%, 59.4% inpatient, and high risk INTERMACS profiles (74.5% profile 1-3). HF cardiologists (49.1%) were the most common originating referral source; least common (4.9%) were electrophysiologists. Common clinical triggers for referral included worsening heart failure (30.0%), inotrope dependence (19.6%), hospitalization (19.4%) and cardiogenic shock (17.8%). Most commonly, AHF therapies were not offered due to patients being too sick (38.0 - 45.1%) or 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.

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