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 performed a retrospective analysis of patients referred to 9 AHF centers for evaluation for AHF therapies. Patient demographics, referring provider characteristics, referral circumstances, and evaluation outcomes were collected.

Majority of referrals (N=515) were male (73.4%), with a majority of those in the advanced disease state: very low LVEF <20% in 51.5%, 59.4% inpatient, and high risk INTERMACS profiles (74.5% profile 1-3). HF cardiologists (49.1%) were the most common originating referral source; least common (4.9%) were electrophysiologists. Common clinical triggers for referral included worsening heart failure (30.0%), inotrope dependence (19.6%), hospitalization (19.4%) and cardiogenic shock (17.8%). Most commonly, AHF therapies were not offered due to patients being too sick (38.0 - 45.1%) or psychosocial reasons (20.3 - 28.6%). Compared to non-HF cardiologists, patients referred by HF cardiologists were offered an AHF therapy more often (66.8% vs 58.4% p=0.0489). Of those not offered any AHF therapy, 28.4% received home inotropic therapy and 14.5% were referred to hospice.

In this multicenter review of AHF referrals, HF cardiologists referred the most patients despite being a relatively small proportion of the overall clinician population. Late referral was prevalent in this high-risk patient population and correlates with worsened outcomes, suggesting a significant need for broad clinician education regarding the benefits, triggers and appropriate timing of referral to AHF centers for optimal patient outcomes.