Referral in Healthcare: A Matter Close to the Heart

According to the latest data available, heart disease remains the leading cause of death in the United States.¹ Because it’s such a large burden on the country’s healthcare system, we need to ensure that all healthcare professionals are working together to provide superior care and improve outcomes for the approximately 6 million Americans living with heart failure. This is especially true for the 600,000 patients with an advanced form of heart failure for whom traditional therapies no longer work.²

For these patients, heart pumps and/or heart transplants are the only options, but the prospect of getting a suitable donor heart remains slim due to long waiting time on the transplant waiting list.³ Unfortunately, while an estimated 250,000 advanced heart failure patients would benefit from a heart transplant, only about 2,500 hearts are available each year.⁴ Only half of all candidates listed on the heart transplant list receive a donor heart within nine months, and some wait upward of two years – making time of the essence for specialists and referring physicians.⁵ But some of these patients do have options! Robust referral networks and improved therapy awareness have both started to make an impact.

Referrals: A Team Effort

Heart failure is largely misunderstood – even in the medical community. It is often misdiagnosed, and the risk factors are not identified or addressed early enough, making the condition difficult to manage and treat. Primary care physicians referring their patients to a heart failure specialist can dramatically improve the future course of care for these patients. Referrals aren’t just about second opinions; they are about improving access to highly specialized treatment options that could be the difference between life and death. 

Naturally, referring physicians could feel like they’re losing control of their patient or the situation when they refer them to a heart failure specialist – when that isn’t the case at all. A physician referring a patient to a specialist or a team of specialists is not a negative reflection of the quality of care; in fact, it's just the opposite. A referral is often the best thing to do when a primary care physician has exhausted all other appropriate options and needs to seek counsel on ways to save and improve a patient’s life.

As a cardiothoracic surgeon, I often see patients referred when they are in the advanced stages of their disease. This provides the opportunity to start a conversation with the patient’s initial healthcare provider, so their future patients can hopefully benefit from a timely—typically earlier—referral. This can be as simple as an email letting the primary care physician know they were successful in treating the patient or commending them on taking an initial course of action. Engaging in this type of open dialogue and cross-practice communication provides the referring physicians and physician assistants an opportunity to highlight specific patient needs and improve their overall care.

This type of relationship-building can help determine which treatments are right for each person. Shared experiences and similar cases can help a treatment team put that final piece of the puzzle together to help a patient achieve the best outcome possible. We are not taking the place of the primary care physician, and we are not taking patients away from them; we are partnering with our family physicians in delivering superior care.

Time Is of the Essence

Heart failure is often diagnosed when the disease begins to have serious health consequences – where people are struggling to walk or even breathe on their own. Heart failure risk factors, such as the reduced ability to exercise and a loss of appetite, may be misattributed to aging – when they are actually something more serious.⁶ In a worst-case scenario, the disease goes unrecognized and advances to the point where a referral to a specialist happens too late. Patients in an advanced stage of heart failure can require significant interventions to slow the disease’s progression and extend their life expectancy, but these measures often require a patient to be healthy enough to complete and recover from the procedure. 

In the advanced stage, intravenous medications can be an alternative, as well as implanted heart pumps and heart transplants. One option that has helped advanced heart failure patients is a mechanical heart pump that can either be used for patients currently waiting for a heart transplant (known as “bridge to transplant”), or for those who are not candidates for heart transplant surgery (“destination therapy”). A mechanical heart pump, such as Abbott’s HeartMate 3^™device, can alleviate the strain on the person’s failing heart and restore blood flow throughout the body, which can be life-saving and even life-extending for some patients. 

Embracing the Power of a Referral

In disease areas like oncology, patients have a team of oncologists, radiologists, physician assistants and nurses helping them with various aspects of their treatment journey. We should be doing the same for advanced heart failure. We can improve the likelihood of a referral if – as a combined team of primary care physicians and specialists – weare educated about the diagnosis and treatment options.

The power of a referral cannot be overstated. In my experience, if a referral comes when the patient is stable and not experiencing a medical emergency, it provides the time needed to make the most informed decision possible and agree on a treatment plan. As a collective medical community, let’s work together to educate the public about heart disease, specifically heart failure, and use our collective expertise to help patients live longer and healthier lives. 

INDICATIONS AND IMPORTANT SAFETY INFORMATION

Rx Only
Brief Summary: Prior to using these devices, please review the Instructions For Use for a complete listing of indications, contraindications, warnings, precautions, potential adverse events and directions for use.Indications: The HeartMate 3™ Left Ventricular Assist System is indicated for providing short- and long-term mechanical circulatory support (e.g., as bridge to transplant or myocardial recovery, or destination therapy) in patients with advanced refractory left ventricular heart failure.Contraindications: The HeartMate 3™ Left Ventricular Assist System is contraindicated for patients who cannot tolerate, or who are allergic to, anticoagulation therapy.Adverse Events: Adverse events that may be associated with the use of the HeartMate 3™ Left Ventricular Assist System are: death, bleeding, cardiac arrhythmia, localized infection, right heart failure, respiratory failure, device malfunctions, driveline infection, renal dysfunction, sepsis, stroke, other neurological event (not stroke-related), hepatic dysfunction, psychiatric episode, venous thromboembolism, hypertension, arterial non-central nervous system (CNS) thromboembolism, pericardial fluid collection, pump pocket or pseudo pocket infection, myocardial infarction, wound dehiscence, hemolysis (not associated with suspected device thrombosis) or device thrombosis.

^TM Indicates a trademark of the Abbott group of companies.

References

1. Centers For Disease Control. Mortality in the United States. Retrieved from: https://www.cdc.gov/nchs/products/databriefs/db328.htmJuly 16, 2019
2. American Heart Association. Living With Heart Failure and Managing Advanced Heart Failure. Retrieved from: https://www.heart.org/en/health-topics/heart-failure/living-with-heart-failure-and-managing-advanced-hf. July 16, 2019
3. Treatment Options for End-Stage Heart Failure. Retrieved from: https://www.webmd.com/heart-disease/heart-failure/end-stage-heart-failure-treatments#1July 16, 2019
4. Brigham and Women’s Hospital. Heart Transplant for Heart Failure. Retrieved from https://www.brighamandwomens.org/heart-and-vascular-center/resources/heart-transplantJuly 22, 2019
5. Goldstein BA, Thomas L, Zaroff JG, Nguyen J, Menza R, Khush KK. Assessment of Heart Transplant Waitlist Time and Pre- and Post-transplant Failure: A Mixed Methods Approach. Epidemiology. 2016;27(4):469–476. doi:10.1097/EDE.0000000000000472
6. Mayo Clinic. Heart Failure Symptoms. Retrieved from: https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142