PMID- 24161453
OWN - NLM
STAT- MEDLINE
DCOM- 20140415
LR  - 20180710
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 63
IP  - 7
DP  - 2014 Feb 25
TI  - Triage of patients with moderate to severe heart failure: who should be referred 
      to a heart failure center?
PG  - 661-671
LID - S0735-1097(13)05753-7 [pii]
LID - 10.1016/j.jacc.2013.10.017 [doi]
AB  - OBJECTIVES: The purpose of this study was to evaluate simple criteria for 
      referral of patients from the general practitioner to a heart failure (HF) 
      center. BACKGROUND: In advanced HF, the criteria for heart transplantation, left 
      ventricular assist device, and palliative care are well known among HF 
      specialists, but criteria for referral to an advanced HF center have not been 
      developed for generalists. METHODS: We assessed observed and expected all-cause 
      mortality in 10,062 patients with New York Heart Association (NYHA) functional 
      class III to IV HF and ejection fraction <40% registered in the Swedish Heart 
      Failure Registry between 2000 and 2013. Next, 5 pre-specified universally 
      available risk factors were assessed as potential triggers for referral, using 
      multivariable Cox regression: systolic blood pressure </=90 mm Hg; creatinine >/=160 
      mumol/l; hemoglobin </=120 g/l; no renin-angiotensin system antagonist; and no 
      beta-blocker. RESULTS: In NYHA functional class III to IV and age groups </=65 
      years, 66 to 80 years, and >80 years, there were 2,247, 4,632, and 3,183 
      patients, with 1-year observed versus expected survivals of 90% versus 99%, 79% 
      versus 97%, and 61% versus 89%, respectively. In the age </=80 years group, the 
      presence of 1, 2, or 3 to 5 of these risk factors conferred an independent hazard 
      ratio for all-cause mortality of 1.40, 2.30, and 4.07, and a 1-year survival of 
      79%, 60%, and 39%, respectively (p < 0.001). CONCLUSIONS: In patients </=80 years 
      of age with NYHA functional class III to IV HF and ejection fraction <40%, 
      mortality is predominantly related to HF or its comorbidities. Potential heart 
      transplantation/left ventricular assist device candidacy is suggested by >/=1 risk 
      factor and potential palliative care by multiple universally available risk 
      factors. These patients may benefit from referral to an advanced HF center.
CI  - Copyright (c) 2014 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Thorvaldsen, Tonje
AU  - Thorvaldsen T
AD  - Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of 
      Cardiology, Karolinska University Hospital, Stockholm, Sweden.
FAU - Benson, Lina
AU  - Benson L
AD  - Department of Clinical Science and Education, Karolinska Institutet, SoS, 
      Stockholm, Sweden.
FAU - Stahlberg, Marcus
AU  - Stahlberg M
AD  - Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of 
      Cardiology, Karolinska University Hospital, Stockholm, Sweden.
FAU - Dahlstrom, Ulf
AU  - Dahlstrom U
AD  - Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, 
      Faculty of Health Sciences, Linkoping University, and Department of Cardiology 
      UHL, County Council of Ostergotland, Linkoping, Sweden.
FAU - Edner, Magnus
AU  - Edner M
AD  - Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
FAU - Lund, Lars H
AU  - Lund LH
AD  - Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of 
      Cardiology, Karolinska University Hospital, Stockholm, Sweden. Electronic 
      address: lars.lund@alumni.duke.edu.
LA  - eng
PT  - Journal Article
DEP - 20131030
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Heart Failure/*diagnosis/*epidemiology/therapy
MH  - Heart Transplantation/trends
MH  - *Hospitalization/trends
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Referral and Consultation/trends
MH  - Registries
MH  - Risk Factors
MH  - *Severity of Illness Index
MH  - Stroke Volume/physiology
MH  - Sweden/epidemiology
MH  - Triage/*methods
OTO - NOTNLM
OT  - heart failure
OT  - heart transplantation
OT  - left ventricular assist device
OT  - palliative care
OT  - referral
EDAT- 2013/10/29 06:00
MHDA- 2014/04/16 06:00
CRDT- 2013/10/29 06:00
PHST- 2013/07/22 00:00 [received]
PHST- 2013/09/16 00:00 [revised]
PHST- 2013/10/08 00:00 [accepted]
PHST- 2013/10/29 06:00 [entrez]
PHST- 2013/10/29 06:00 [pubmed]
PHST- 2014/04/16 06:00 [medline]
AID - S0735-1097(13)05753-7 [pii]
AID - 10.1016/j.jacc.2013.10.017 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2014 Feb 25;63(7):661-671. doi: 10.1016/j.jacc.2013.10.017. 
      Epub 2013 Oct 30.