Heart failure affects more than 6 million adults in the United States, and as many as 5% of these individuals progress to advanced or end-stage disease where treatment is largely limited to left ventricular assist device implantation or heart transplant.
Identifying patients who are ideal candidates for heart transplant has required generalists to reference a body of literature for best practices, and there remains a lot of variation across transplant centers.
An invited review recently published in the Journal of the American Medical Association (JAMA) by Vanderbilt Health authors aims to synthesize information and put it in one convenient document to help anyone taking care of patients with heart failure.
“Existing resources are either old, or they’re spread across multiple documents rather than being collated into one clear reference that someone can easily look to,” said Kaushik Amancherla, MD, Assistant Professor of Medicine and first author of the paper.
Amancherla said a main takeaway of the document is it’s never too early for a provider to refer a patient to a transplant specialist for evaluation if they are concerned.
“It’s always better to send them too soon, and we can identify problems that they can improve on in case they need something like a heart transplant down the road, whether it’s quitting smoking or ensuring they have enough caregiver support,” Amancherla said. “If someone gets referred to us too late, irreversible organ damage may have already occurred, and they are no longer a candidate for heart transplant.”
The document is aimed at a generalist audience (family and internal medicine, general cardiologists, and anyone else caring for patients with heart failure) to keep them well informed about the transplant evaluation process, post-transplant sequelae, and important issues that can be addressed in primary care and other clinics (e.g., drug interactions, age-appropriate cancer screening, etc.).
“This invited review in a high-impact journal really recognizes not only our clinical transplant volume, but the research advances that we’ve been making at Vanderbilt Health, whether it’s our surgeons with innovations in preservation technologies or our transplant group in advancing precision medicine,” Amancherla said.
Co-authors of the paper are JoAnn Lindenfeld, MD; Kelly Schlendorf, MD, MHS; Ashish Shah, MD; and Ravi Shah, MD.
