Triage for Advanced Heart Failure: Effect of Regional Wait Time Disparity

Purpose Ventricular assist devices (VAD) and heart transplantation (OHT) improve survival and quality of life in highly-selected patients, but the thresholds for considering ambulatory patients for advanced therapies remains unclear. The purpose of this study was to compare the characteristics and outcomes of patients at referral centers based on their median wait time to OHT. Methods and Materials The MedaMACS Screening Pilot Study enrolled patients from 10 US advanced heart failure centers, including those with INTERMACS profiles 4-7, EF ≤ 30%, and ≥1 heart failure hospitalization in the past year. Patients were divided based on the median wait time to OHT for Status 1A patients in their region: Group 1, ≤ 30 days, and Group 2, > 30 days. Clinical characteristics and outcomes were compared. Results Of 168 MedaMACS patients, 47 (28%) were in Group 1 and 121 (72%) were in Group 2. There was no difference in demographic or clinical characteristics, including symptoms, signs, echocardiographic or hemodynamic parameters. There were significantly more patients evaluated for OHT in Group 1 (53%) vs Group 2 (28%; p Table ). Conclusions Triage for advanced heart failure therapies at US centers appears to be driven by geography: centers with shorter median wait time to OHT are more likely to evaluate patients for OHT and less likely to place VADs. As patients at these different centers do not differ clinically, further study is needed to assess whether threshold for considering patients for advanced therapies should be determined by wait time to transplant as well as clinical considerations. Median wait time to transplant in the region for Status 1A patients in the region Group 1: ≤30 days (N = 48) Group 2: >30 days (N = 121) Death 15% (7) 22% (26) Transplantation * 25% (12) 7% (8) VAD * 2% (1) 18% (21) * p