Impact of a multidisciplinary heart failure management program in ambulatory patients with heart failure with reduced ejection fraction referred for advanced heart failure therapy

Abstract Objectives To assess 1-year outcomes of patients with heart failure with reduced ejection fraction (HF-rEF) who referred to a multidisciplinary heart failure (HF) clinic for advanced HF therapy. Methods We studied consecutive 312 ambulatory patients (mean age 51 years, 79% male) with HF-rEF (mean EF 23±8%) who were referred from cardiologists and cardiac surgeons to a multidisciplinary advanced HF clinic. The study patients were divided into 3 groups based on HF/transplant cardiologist evaluation. Group A consisted of 65 patients who were listed for heart transplant (HTx). Group B consisted of 157 patients who were considered as potential HTx candidates but who were too well to be listed for HTx. All patients in this group were not on optimal medical therapy (OMT) for HF-rEF at the time of evaluation. Group C consisted of 90 patients who were not suitable for HTx. Primary outcomes included HTx, left ventricular assist device (LVAD), or death. Outcomes were assessed at baseline and at 1 year after referral Results During the mean follow-up period of 9.6±4.1 months, 88 primary outcomes (28%) occurred (43 deaths (14%), 42 HTxs (14%) and 3 LVAD implants (1%)). Patients in group A, B, and C had a1-year survival of 91%, 90%, and 78%, respectively. At 1-year follow-up, 59%, 3%, and 0% in patients in group A, B, and C underwent HTx. The median waiting time for HTx was 5 months. At 1 year after referral, there was a 20%, 92%, and 63% reduction in HF admission in group A, B, and C, respectively; 44 HF admissions (0.2%/patients) occurred at 1 year after referral, compared with 530 HF admissions (1.7%/patients) 1 year before referral (p