TY - JOUR
T1 - An international survey to assess referral thresholds for destination therapy in non-inotrope-dependent patients
T2 - Results of the CONSENSUS-DT study
AU - Galvao, Marie
AU - Saeed, Omar
AU - Immekus, Jason
AU - Goldstein, Daniel J.
AU - Maybaum, Simon
N1 - Funding Information:
Dr Maybaum has served as a consultant for Thoratec and Heartware and received research grant support from Texas Instruments. Dr Goldstein has served as a consultant for Thoratec.
PY - 2014/7
Y1 - 2014/7
N2 - Background Criteria for the identification of patients who may progress to advanced heart failure (HF) have been previously suggested. However, identification of appropriate non-inotrope-dependent (NID) patients for destination therapy (DT) remains a challenge, and referral rates are low. We surveyed expert provider opinion about patient selection for early DT. Methods An internet-based survey was sent to international HF providers to investigate opinions about clinical indicators for referral of NID patients for DT. Subjects were identified from membership lists of HF professional organizations. Respondents provided their level of agreement with the use of a 5-point Likert Scale (1 = strongly disagree to 5 = strongly agree) to 10 clinical criteria describing at-risk NID patients. Results A total of 231 respondents who had been in a position to recommend left ventricular assist device (LVAD) therapy for 7.6 ± 5.8 years identified themselves as HF providers: 41% HF cardiologists, 27% HF nurse practitioners, 21% cardiothoracic surgeons, 9% LVAD coordinators, and 2% general cardiologists. More than two-thirds of the respondents agreed or strongly agreed with 7 of the 10 items. Similar consensus was not seen for 6-minute walk (6MW) or B-type natriuretic peptide (BNP). When asked which criteria would have to be present for LVAD referral, only hemodynamic deterioration reached 50% affirmation among respondents. No criteria reached >50% response as being sufficient alone for DT. Conclusion We describe referral thresholds for early LVAD therapy among international HF providers. With the exception of BNP and 6MW, we found overall agreement on the proposed clinical parameters. Despite apparent consensus, in practice implantation rates for LVAD in NID patients remain low. The results of ongoing clinical trials in this population may lower thresholds for early referral for DT.
AB - Background Criteria for the identification of patients who may progress to advanced heart failure (HF) have been previously suggested. However, identification of appropriate non-inotrope-dependent (NID) patients for destination therapy (DT) remains a challenge, and referral rates are low. We surveyed expert provider opinion about patient selection for early DT. Methods An internet-based survey was sent to international HF providers to investigate opinions about clinical indicators for referral of NID patients for DT. Subjects were identified from membership lists of HF professional organizations. Respondents provided their level of agreement with the use of a 5-point Likert Scale (1 = strongly disagree to 5 = strongly agree) to 10 clinical criteria describing at-risk NID patients. Results A total of 231 respondents who had been in a position to recommend left ventricular assist device (LVAD) therapy for 7.6 ± 5.8 years identified themselves as HF providers: 41% HF cardiologists, 27% HF nurse practitioners, 21% cardiothoracic surgeons, 9% LVAD coordinators, and 2% general cardiologists. More than two-thirds of the respondents agreed or strongly agreed with 7 of the 10 items. Similar consensus was not seen for 6-minute walk (6MW) or B-type natriuretic peptide (BNP). When asked which criteria would have to be present for LVAD referral, only hemodynamic deterioration reached 50% affirmation among respondents. No criteria reached >50% response as being sufficient alone for DT. Conclusion We describe referral thresholds for early LVAD therapy among international HF providers. With the exception of BNP and 6MW, we found overall agreement on the proposed clinical parameters. Despite apparent consensus, in practice implantation rates for LVAD in NID patients remain low. The results of ongoing clinical trials in this population may lower thresholds for early referral for DT.
KW - Heart failure
KW - inotropes
KW - left ventricular assist device
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U2 - 10.1016/j.cardfail.2014.05.004
DO - 10.1016/j.cardfail.2014.05.004
M3 - Article
C2 - 24858055
AN - SCOPUS:84903843464
SN - 1071-9164
VL - 20
SP - 492
EP - 497
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 7
ER -