2021/09/10 by Alanna A. Morris, Prateeti Khazanie, Mark H. Drazner +7 · 193 citations
Engineering · Medicine · #Cardiac Structural Anomalies and Repair #Disease #Family medicine #Heart Failure Treatment and Management #Heart disease #Heart failure #Intensive care medicine #Internal medicine #Mechanical Circulatory Support Devices #Medical emergency #Medicine #Multidisciplinary approach #Referral
paper · pdf · doi:10.1161/cir.0000000000001016
published in Circulation 144(15), e238-e250 (Lippincott Williams & Wilkins)
openalex publication_date 2021/09/10 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30
Among the estimated 6.2 million Americans living with heart failure (HF), ≈5%/y may progress to advanced, or stage D, disease. Advanced HF has a high morbidity and mortality, such that early recognition of this condition is important to optimize care. Delayed referral or lack of referral in patients who are likely to derive benefit from an advanced HF evaluation can have important adverse consequences for patients and their families. A 2-step process can be used by practitioners when considering referral of a patient with advanced HF for consideration of advanced therapies, focused on recognizing the clinical clues associated with stage D HF and assessing potential benefits of referral to an advanced HF center. Although patients are often referred to an advanced HF center to undergo evaluation for advanced therapies such as heart transplantation or implantation of a left ventricular assist device, there are other reasons to refer, including access to the infrastructure and multidisciplinary team of the advanced HF center that offers a broad range of expertise. The intent of this statement is to provide a framework for practitioners and health systems to help identify and refer patients with HF who are most likely to derive benefit from referral to an advanced HF center.