Patient Referral
If your patient experiences any of the following, refer them to a heart failure specialist for evaluation for advanced heart failure therapies, including LVAD therapy.1
High-Risk Clinical Triggers
IV inotropes
NYHA IIIB/IV or persistently elevated natriuretic peptides
End-organ dysfunction (Cr > 1.8 mg/dL or BUN > 43 mg/dL)
EF ≤ 35%
Defibrillator shocks
Hospitalizations > 1 with heart failure
Edema (or elevated PA pressure) despite escalating diuretics
Low blood pressure, high heart rate
Prognostic medication — progressive intolerance or down-titration GDMT
EF < 35%
Additional Considerations for Referral:2
- CRT non-responder
- Physical activity limited or impaired QOL
Patient Profile
- NYHA Class IIIB or IV
- Heart failure hospitalization(s)
- Unresponsive to diruetics or neurohormonal agents
Additional Considerations
- Ejection Fraction < 35%1
- Persistently high PA pressures5
- Elevated Pro-BNP or BNP3
- 6MWD < 300m4
Patient Workup
Evaluating a heart failure patient for advanced therapies requires the integration of clinical, imaging, hemodynamic, functional and biomarker data.
The following tests and patient information may be needed when referring a patient for advanced heart failure evaluation and LVAD therapy.3
- Physical examination
- Blood tests
- Chest x-rays
- Electrocardiogram (EKG or ECG)
- Echocardiography (abbreviated as "echo")
- Exercise stress test
- Radionuclide ventriculography or multiple-gated acquisition scanning (abbreviated as MUGA)
- Cardiac catheterization
- Magnetic resonance imaging (MRI)
- 6-Minute Walk Test4
Referring Patients for Evaluation
When you refer your advanced heart failure patients to a HeartMate LVAD implant center, you can reassure them that:
- They will undergo a complete and thorough evaluation to determine if they are a candidate for advanced therapies, including LVAD therapy.
- Both them and their caregivers will receive additional details of the surgery. They’ll also have the opportunity to ask questions about the procedure, recovery, and living with their HeartMate 3 LVAD.
This device is commercially available for use in select international markets.
References
- Maddox TM, Januzzi JL, Allen LA, et al. 2021 update to the 2017 ACC Expert Consensus Decision Pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction. J Am Coll Cardiol. January 2021. doi:10.1016/j.jacc.2020.11.022
- Yancy CW, Januzzi JL Jr, Allen LA, et al. 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol. 2018;71:201-230.
- American Heart Association. Common Tests for Heart Failure. https://www.heart.org/en/health-topics/heart-failure/diagnosing-heart-failure/common-tests-for-heart-failure. Accessed December 16, 2020.
- Giannitsi S, Bougiakli M, Bechlioulis A, et al. 6- minute walking test: a useful tool in the management of heart failure patients. Ther Adv Cardiovasc Dis. 2019;13:1-10.
- Kilic A, Katz JN, Joseph SM, et al. Changes in pulmonary artery pressure before and after left ventricular assist device implantation in patients utilizing remote haemodynamic monitoring. ESC Heart Failure. 2019;6:138-145.
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