Abstract 14787: Cardio-Renal Syndrome but Not Six Minute Walk or BNP favored as Criteria for Referral for Early LVAD Implantation: Results of the CONSENSUS-DT Study
Background. INTERMACS data shows that very few non inotrope dependent (NID) patients with advanced heart failure (HF) are referred for LVAD as Destination Therapy (DT) and identification of this population remains a challenge. We surveyed provider opinion regarding which NID patients require referral for DT.
Methods. An internet-based survey was sent to international HF providers to investigate opinions about clinical indicators for referral of NID patients for LVAD as DT. Subjects were identified from membership lists of HF professional organizations. Respondents were asked to score their level of agreement with 10 clinical markers describing at risk NID patients.
Results. A total of 231 respondents identified themselves as HF providers and are included in the analysis. Respondents were: 41% HF cardiologists, 27% HF nurse practitioners, 21% cardiothoracic surgeons, 9% LVAD coordinators, 2% general cardiologists and had been in a position to recommend LVAD therapy for 7.6±5.8 years. The cumulative categorizations of responses to each of the ten items are shown in Figure 1. More than two thirds of respondents strongly agreed or agreed with 7 of the 10 items. Similar consensus was not seen for 6 min walk and BNP. When asked which criteria would have to be present for LVAD referral only item 1 reached >50% affirmation amongst respondents. No criteria reached >50% response as being sufficient alone for referral for DT.
Conclusion. This is the first survey to describe opinion amongst HF providers about referral thresholds for early LVAD therapy. With the exception of BNP and 6 min walk, we found overall agreement on the proposed clinical parameters. Despite apparent consensus, referral rates remain low. Ongoing clinical trials for LVAD as DT may increase referral of NID patients.
- © 2012 by American Heart Association, Inc.