Importance of a Partnered Heart Failure Network to Increase Access to Advanced Heart Failure Therapies

Abstract

Purpose Our hypothesis is that by improving access to advanced heart failure specialists (AHFS) through partnered outreach clinics, we can increase the number of patients benefitted by advanced heart failure (AHF) therapies delivered at our center. This partnered network approach can potentially overcome distance barriers, optimize referral timing, and expedite access to AHFS from the regional center of excellence. Methods Three AHFS from our center participated in 7 heart failure outreach clinics in cities up to 400 miles away from our center in partnership with local cardiology providers. Phase 1 (6/2014 - 6/2016) was prior to opening outreach clinics 2-6. Phase 2 (7/2016 - 9/2018) is after opening these outreach clinics, while outreach clinic 1 was closed. Clinics 4,5, and 7 were opened in the last 8 months of Phase 2. We compared total referral volume, number of mechanical circulatory support (MCS) implants, and number of heart transplants (HTX) between these periods. Results There was an overall 59% increase in AHF referrals after establishing local, partnered access to an AHFS. The change in referral volume drove a 48% increase in MCS implants as well as a 38% increase in transplant volumes, although the absolute numbers of transplants were fairly low. Several sites that were opened recently (4,5,7) showed rapid growth, suggesting an unmet need in those locations. At the one site where we withdrew an AHFS from, there was a 24% reduction in referrals seen, with no change in already low volumes of MCS or HTX. Conclusion The placement of an AHFS in a community in partnership with referring cardiologists drove growth in heart failure referrals, with a concomitant rise in MCS and HTX volumes. In our region, partnership of an AHFS with referring cardiology providers increased access to AHF therapies, specifically MCS and HTX. Additional studies to understand the best strategies to increase access to AHFS should be undertaken.