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Screening for heart transplantation and left ventricular assist system: results from the ScrEEning for advanced Heart

Lars H Lund1,2, Jean-Noel Trochu3, Bart Meyns4

  • 1Department of Medicine, Karolinska Institutet, Stockholm, Sweden.

European Journal of Heart Failure
|September 30, 2017
PubMed

Insights

Screening identified eligible candidates for advanced heart failure treatments like heart transplantation (HTx) and left ventricular assist systems (LVAS) among patients with existing devices. However, many eligible patients declined intervention, highlighting a gap between clinical assessment and patient readiness.

Area of Science:

  • Cardiology
  • Advanced Heart Failure Management

Background:

  • Heart transplantation (HTx) and left ventricular assist systems (LVAS) are crucial for advanced heart failure but may be underutilized.
  • Screening protocols can potentially identify suitable candidates for these life-saving interventions.

Purpose of the Study:

  • To evaluate the effectiveness of a screening program in identifying patients with advanced heart failure who are candidates for HTx or LVAS.
  • To assess the prevalence of undiagnosed eligibility for advanced therapies in patients with existing cardiac devices.

Main Methods:

  • The SEE-HF study prospectively screened patients with cardiac resynchronization therapy (CRT) and/or implantable cardioverter-defibrillator (ICD) and ejection fraction ≤40% (NYHA class III-IV).
  • Eligible patients were assessed for guideline-based HTx and LVAS indications.
  • Screening occurred across multiple centers in seven European countries.

Main Results:

  • Out of 1722 patients screened, 7.0% were eligible, and 5.7% were enrolled for detailed assessment.
  • 26% of enrolled patients were eligible for HTx or LVAS.
  • 11 patients were listed for HTx, and 3 received an LVAS.

Conclusions:

  • A significant proportion of patients with CRT/ICD and advanced heart failure have unrecognized eligibility for HTx or LVAS.
  • Patient willingness to accept advanced therapies remains a barrier, indicating a discrepancy between clinical indication and patient acceptance.
  • Screening effectively identifies candidates, but patient decision-making influences intervention rates.
Abstract

Keywords:
Heart failureHeart transplantationLeft ventricular assist systemMechanical circulatory supportScreening

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