Mapping the Heart Failure Referral Pathway, from Transplant Center to Private Practice
A cardiologist's practice setting shapes how they view advanced heart failure therapy and whether they refer for it.
A company developing a partial-support mechanical circulatory support device wanted to understand how US cardiologists would view it and where it might fit in the referral pathway.
The recruit was designed to cover the range of settings a patient might pass through:
Board-certified heart failure cardiologists in LVAD and transplant programs
Heart failure cardiologists in LVAD-only centers
General cardiologists in large tertiary centers, separate from in-house LVAD and transplant programs
General cardiologists in community hospitals
Office-based general cardiologists in private practice
Interviews were held at the American Heart Association Scientific Sessions in Philadelphia. Each lasted 90 minutes, allowing detailed discussion of how patients move between settings.
The final sample comprised 20 participants: 8 heart failure specialists and 12 general cardiologists. One respondent recruited as a heart failure specialist was classified as a general cardiologist in the analysis, based on their description of their practice.
Setting made a clear difference. Heart failure specialists reported far higher LVAD volumes than general cardiologists in community practice. Some community cardiologists said their patients were rejected so often that they had become reluctant to refer, with family pressure sometimes prompting a referral instead.
Recruiting across the spectrum, rather than only at transplant centers, made those referral barriers visible. A parallel European study at ESC allowed the findings to be compared across markets.
