Early Referral to Primary Cardiologist Improves Advanced Heart Failure Patient Outcomes
Rapid technological and medical advances have allowed patients with advanced heart failure (HF) to live longer and enjoy a better quality of life; however, these same advances have also made HF patient management far more complex.1 Much of this patient management is done at specialized transplant centers like Penn State Heart and Vascular Institute of Penn State Health Milton S. Hershey Medical Center, a tertiary advanced HF site. Penn State offers procedures and treatments for both ventricles, including several types of left ventricular assist devices (LVADs), as well as biventricular assist devices, or total artificial hearts (TAHs), in addition to heart transplantation and heart failure clinical trials.
Penn State Heart and Vascular Institute is one of a small number of advanced HF centers that has significant experience with the TAH and is able to offer this procedure. Penn State is also a center for the trial of the HeartMate 3TM LVAD device, which is projected to carry a lower incidence of pump thrombosis.
“All our advanced heart failure patients are assessed by a multidisciplinary team prior to a decision being made regarding next steps,” says Omaima Ali, MD, associate medical director, Penn State Heart and Vascular Institute Heart Transplant Program. “The key factor in successful outcomes is that each patient’s primary provider involves our team as soon as possible. This provides us the opportunity to treat the patient before he or she becomes too sick to be eligible for the available options.” As the initial referrers, primary cardiologists or providers are the gatekeepers to their patients. As a result, the Penn State advanced HF team has increased outreach to the primary cardiology community throughout its region.
While the Penn State team offers many treatment options to its HF patients, the initial referral must come from the patient’s primary cardiologist, and the earlier the referral, the better the opportunity to ensure optimal outcomes. “The timing of the primary cardiologist referral is critical. It is never too soon,” Dr. Ali emphasizes. “Even if a heart failure patient is ‘too well’ to require a more advanced intervention initially, it’s important to allow us to jointly follow these cases. Early identification allows intervention before patients sustain major end-organ damage or become too frail to tolerate the procedures.”
Associate Medical Director, Heart Transplant Program Penn State Heart and Vascular Institute
Fellowship: Heart failure and transplant, Mid America Heart Institute/UMKC, Kansas City, Mo.; Cardiology, Wayne State University, DMC Graduate Medical Education, Detroit, Mich.
Residency: Internal medicine, Wayne State University, DMC Graduate Medical Education, Detroit, Mich.
Medical School: University of Khartoum Faculty of Medicine, Sudan
Connect with Omaima A. Ali, MD, on Doximity
- Fanaroff AC, DeVore AD, Mentz RJ, Daneshmand MA, and Patel CB. Patient selection for advanced heart therapy referral. Crit Pathw Cardiol. 2014 March;13(1):1-5.
- Barge-Caballero E, Segovia-Cubero J, Almenar-Bonet L, et al. Preoperative INTERMACS profiles determine postoperative outcomes in critically ill patients undergoing emergency heart transplantation. analysis of the Spanish National Heart Transplant Registry. Circ Heart Fail. 2013;6:763-772.