Barriers To Durable Left Ventricular Assist Device Referrals

Document Type

Conference Proceeding

Publication Date


Publication Title

J Card Fail


Introduction: While heart transplantation remains the gold standard for patients with end stage heart failure, implantation of durable left ventricular assist devices (LVAD) can improve survival and quality of life for patients with stage D heart failure (HFD). Given the limited supply of heart donors, the use of LVAD is critical to meet the therapeutic needs for patients with HFD. Data suggest that the majority of patients with HFD do not undergo evaluation for LVAD. Given the lack of therapeutic options for patients with HFD, barriers to referral and evaluation have a significant adverse impact on patient outcomes. We asked providers involved in the care of patients with HFD across the United States to complete a survey pertaining to potential LVAD referral to better characterize barriers to LVAD referral. Hypothesis: Referral timing and understanding indications for LVAD by referring providers are two important barriers for HFD patients. Methods: We designed and dispersed a 23-question survey for providers of heart failure patients through social media platforms. Provider demographic information, perceived knowledge of the benefits and complications of LVAD therapy, as well as potential barriers to referral were assessed. Survey data was analyzed to identify and characterize referral barriers for LVAD therapy. Results: 99 providers responded from 24 different centers. Figure 1 summarizes the pertinent findings from the survey. 64% were non-advanced heart failure cardiologists (AHFCs). Most responders were either employed by a health system or private practice. The majority of non-AHFCs self-identified as comfortable with identifying HFD. However, they underestimated survival post LVAD implantation, overestimated complications, and demonstrated frustration with the referral process. The most common reason for frustration was the lack of communication between referring physicians and LVAD centers. The most common reason they did not refer was due to pre-existing comorbidities. Conclusions: Results from a geographically and institutionally diverse population of referring providers suggest a knowledge gap in the risk of and outcomes from LVAD implantation resulting in under-referral of patients for advanced mechanical assist device support. LVAD centers should recognize that communication is key in maintaining a good relationship with referring providers.



First Page