Abstract 12052: Breaking the Barriers in Heart Failure Care: Understanding Patient Referral Practices to Advanced Heart Failure Centers
BackgroundAdvanced Heart Failure (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. We evaluated patient referral patterns to identify barriers for successful...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A12052-A12052 |
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| container_end_page | A12052 |
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| container_issue | Suppl_1 Suppl 1 |
| container_start_page | A12052 |
| container_title | Circulation (New York, N.Y.) |
| container_volume | 140 |
| creator | Herr, Jared J Ravichandran, Ashwin Chien, Christopher Forest, Stephen J D’Souza, Benjamin |
| description | BackgroundAdvanced Heart Failure (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. We evaluated patient referral patterns to identify barriers for successful delivery of AHF therapies and to develop methods to better serve the expanding HF population.Methods/ResultsWe performed a retrospective chart analysis of patients referred for and successfully completed an evaluation for AHF therapies at 5 centers (N=334). Data includeddemographics, clinical and referring physician characteristics and evaluation outcomes. The majority of referrals were Caucasian males (48%). At time of evaluation, 37% were INTERMACS profile 1-2 and 53% had an LVEF |
| doi_str_mv | 10.1161/circ.140.suppl_1.12052 |
| format | Article |
| fullrecord | <record><control><sourceid>wolterskluwer</sourceid><recordid>TN_cdi_wolterskluwer_health_00003017-201911191-01181</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>00003017-201911191-01181</sourcerecordid><originalsourceid>FETCH-wolterskluwer_health_00003017-201911191-011813</originalsourceid><addsrcrecordid>eNqdjk1OwzAQhS0EEuHnCmgukOBxkoZ011ZUXVYI1tGQTImp5VZjhx6Ba5MgVl2yGD09PX2fRqkH1BniDB9bK22Ghc7CcDy6BjM0ujQXKsHSFGlR5vWlSrTWdVrlxlyrmxA-xzrLqzJR34v3EIXaCL_UHJbCtLf-A2LPsCQRyxLAetgwSYQ1WTcIw4qE5_Dmu3GN5LuJ2FK07CO88I5FyMF2EtuWA8QDLLov8i1356KRGB136mpHLvD9X96qYv38utqkp4Ob9r0bTixNz-Ri34zv61xjlRqNNeJ4qUZ8wvyf2A-8SWJx</addsrcrecordid><sourcetype>Publisher</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Abstract 12052: Breaking the Barriers in Heart Failure Care: Understanding Patient Referral Practices to Advanced Heart Failure Centers</title><source>American Heart Association Journals</source><source>Journals@Ovid Complete</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Herr, Jared J ; Ravichandran, Ashwin ; Chien, Christopher ; Forest, Stephen J ; D’Souza, Benjamin</creator><creatorcontrib>Herr, Jared J ; Ravichandran, Ashwin ; Chien, Christopher ; Forest, Stephen J ; D’Souza, Benjamin</creatorcontrib><description>BackgroundAdvanced Heart Failure (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. We evaluated patient referral patterns to identify barriers for successful delivery of AHF therapies and to develop methods to better serve the expanding HF population.Methods/ResultsWe performed a retrospective chart analysis of patients referred for and successfully completed an evaluation for AHF therapies at 5 centers (N=334). Data includeddemographics, clinical and referring physician characteristics and evaluation outcomes. The majority of referrals were Caucasian males (48%). At time of evaluation, 37% were INTERMACS profile 1-2 and 53% had an LVEF <20%. HF cardiologists (48%) were the originating referral source most often while electrophysiologists (6%) and cardiac surgeons (3%) were the least. Common clinical triggers for referral included worsening heart failure (27%), inotrope dependence (21%), hospitalization (20%) and cardiogenic shock (18%). Of patients referred 61% were deemed eligible for at least one AHF therapy. Most commonly, AHF therapies were not offered for psychosocial reasons and medical comorbidities. Of those not offered any AHF therapy, 20% received home inotropic therapy, 19% were deemed too well, and 10% were referred to hospice.ConclusionsIn this multi-center review of AHF referrals,HF cardiologists referred the most patients for AHF therapies despite being a relatively small proportion of the overall CV clinician population. This suggests a significant need for broad clinician education of the benefits of AHF therapies to encourage adoption of such treatments. Consistent with prior studies, women and minorities continue to be underrepresented despite significant disease burden, raising concern for gender/race inequities. Additional information is needed on why psychosocial reasons are so often cited for not pursuing AHF therapies and why hospice remains underutilized for Stage D HF patients despite long term inotropic therapy being relatively common. Further investigation into the determinants of why certain strategies are adopted is necessary.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/circ.140.suppl_1.12052</identifier><language>eng</language><publisher>by the American College of Cardiology Foundation and the American Heart Association, Inc</publisher><ispartof>Circulation (New York, N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A12052-A12052</ispartof><rights>2019 by the American College of Cardiology Foundation and the American Heart Association, Inc.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Herr, Jared J</creatorcontrib><creatorcontrib>Ravichandran, Ashwin</creatorcontrib><creatorcontrib>Chien, Christopher</creatorcontrib><creatorcontrib>Forest, Stephen J</creatorcontrib><creatorcontrib>D’Souza, Benjamin</creatorcontrib><title>Abstract 12052: Breaking the Barriers in Heart Failure Care: Understanding Patient Referral Practices to Advanced Heart Failure Centers</title><title>Circulation (New York, N.Y.)</title><description>BackgroundAdvanced Heart Failure (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. We evaluated patient referral patterns to identify barriers for successful delivery of AHF therapies and to develop methods to better serve the expanding HF population.Methods/ResultsWe performed a retrospective chart analysis of patients referred for and successfully completed an evaluation for AHF therapies at 5 centers (N=334). Data includeddemographics, clinical and referring physician characteristics and evaluation outcomes. The majority of referrals were Caucasian males (48%). At time of evaluation, 37% were INTERMACS profile 1-2 and 53% had an LVEF <20%. HF cardiologists (48%) were the originating referral source most often while electrophysiologists (6%) and cardiac surgeons (3%) were the least. Common clinical triggers for referral included worsening heart failure (27%), inotrope dependence (21%), hospitalization (20%) and cardiogenic shock (18%). Of patients referred 61% were deemed eligible for at least one AHF therapy. Most commonly, AHF therapies were not offered for psychosocial reasons and medical comorbidities. Of those not offered any AHF therapy, 20% received home inotropic therapy, 19% were deemed too well, and 10% were referred to hospice.ConclusionsIn this multi-center review of AHF referrals,HF cardiologists referred the most patients for AHF therapies despite being a relatively small proportion of the overall CV clinician population. This suggests a significant need for broad clinician education of the benefits of AHF therapies to encourage adoption of such treatments. Consistent with prior studies, women and minorities continue to be underrepresented despite significant disease burden, raising concern for gender/race inequities. Additional information is needed on why psychosocial reasons are so often cited for not pursuing AHF therapies and why hospice remains underutilized for Stage D HF patients despite long term inotropic therapy being relatively common. Further investigation into the determinants of why certain strategies are adopted is necessary.</description><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid/><recordid>eNqdjk1OwzAQhS0EEuHnCmgukOBxkoZ011ZUXVYI1tGQTImp5VZjhx6Ba5MgVl2yGD09PX2fRqkH1BniDB9bK22Ghc7CcDy6BjM0ujQXKsHSFGlR5vWlSrTWdVrlxlyrmxA-xzrLqzJR34v3EIXaCL_UHJbCtLf-A2LPsCQRyxLAetgwSYQ1WTcIw4qE5_Dmu3GN5LuJ2FK07CO88I5FyMF2EtuWA8QDLLov8i1356KRGB136mpHLvD9X96qYv38utqkp4Ob9r0bTixNz-Ri34zv61xjlRqNNeJ4qUZ8wvyf2A-8SWJx</recordid><startdate>20191119</startdate><enddate>20191119</enddate><creator>Herr, Jared J</creator><creator>Ravichandran, Ashwin</creator><creator>Chien, Christopher</creator><creator>Forest, Stephen J</creator><creator>D’Souza, Benjamin</creator><general>by the American College of Cardiology Foundation and the American Heart Association, Inc</general><scope/></search><sort><creationdate>20191119</creationdate><title>Abstract 12052: Breaking the Barriers in Heart Failure Care: Understanding Patient Referral Practices to Advanced Heart Failure Centers</title><author>Herr, Jared J ; Ravichandran, Ashwin ; Chien, Christopher ; Forest, Stephen J ; D’Souza, Benjamin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-wolterskluwer_health_00003017-201911191-011813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><toplevel>online_resources</toplevel><creatorcontrib>Herr, Jared J</creatorcontrib><creatorcontrib>Ravichandran, Ashwin</creatorcontrib><creatorcontrib>Chien, Christopher</creatorcontrib><creatorcontrib>Forest, Stephen J</creatorcontrib><creatorcontrib>D’Souza, Benjamin</creatorcontrib><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Herr, Jared J</au><au>Ravichandran, Ashwin</au><au>Chien, Christopher</au><au>Forest, Stephen J</au><au>D’Souza, Benjamin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Abstract 12052: Breaking the Barriers in Heart Failure Care: Understanding Patient Referral Practices to Advanced Heart Failure Centers</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><date>2019-11-19</date><risdate>2019</risdate><volume>140</volume><issue>Suppl_1 Suppl 1</issue><spage>A12052</spage><epage>A12052</epage><pages>A12052-A12052</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>BackgroundAdvanced Heart Failure (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. We evaluated patient referral patterns to identify barriers for successful delivery of AHF therapies and to develop methods to better serve the expanding HF population.Methods/ResultsWe performed a retrospective chart analysis of patients referred for and successfully completed an evaluation for AHF therapies at 5 centers (N=334). Data includeddemographics, clinical and referring physician characteristics and evaluation outcomes. The majority of referrals were Caucasian males (48%). At time of evaluation, 37% were INTERMACS profile 1-2 and 53% had an LVEF <20%. HF cardiologists (48%) were the originating referral source most often while electrophysiologists (6%) and cardiac surgeons (3%) were the least. Common clinical triggers for referral included worsening heart failure (27%), inotrope dependence (21%), hospitalization (20%) and cardiogenic shock (18%). Of patients referred 61% were deemed eligible for at least one AHF therapy. Most commonly, AHF therapies were not offered for psychosocial reasons and medical comorbidities. Of those not offered any AHF therapy, 20% received home inotropic therapy, 19% were deemed too well, and 10% were referred to hospice.ConclusionsIn this multi-center review of AHF referrals,HF cardiologists referred the most patients for AHF therapies despite being a relatively small proportion of the overall CV clinician population. This suggests a significant need for broad clinician education of the benefits of AHF therapies to encourage adoption of such treatments. Consistent with prior studies, women and minorities continue to be underrepresented despite significant disease burden, raising concern for gender/race inequities. Additional information is needed on why psychosocial reasons are so often cited for not pursuing AHF therapies and why hospice remains underutilized for Stage D HF patients despite long term inotropic therapy being relatively common. Further investigation into the determinants of why certain strategies are adopted is necessary.</abstract><pub>by the American College of Cardiology Foundation and the American Heart Association, Inc</pub><doi>10.1161/circ.140.suppl_1.12052</doi></addata></record> |
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| source | American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals |
| title | Abstract 12052: Breaking the Barriers in Heart Failure Care: Understanding Patient Referral Practices to Advanced Heart Failure Centers |
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