Outcomes after initial heart failure consultation in Fontan patients

Area of Science:

• Cardiology
• Pediatric Cardiology
• Advanced Heart Failure Management

Background:

• Fontan failure patients represent a high-risk group for heart transplantation and advanced therapies.
• Understanding outcomes after initial heart failure consultation is key for timely referral.
• Optimizing referral timing can significantly impact advanced heart failure care for Fontan patients.

Purpose of the Study:

• To assess the timing and outcomes of initial heart failure consultations for Fontan patients.
• To identify factors associated with late referral for advanced heart failure care.
• To inform strategies for earlier and more effective referral of Fontan patients.

Main Methods:

• A survey study involving heart failure providers managing Fontan patients.
• Data collected on clinical characteristics at initial consultation and 30-day outcomes.
• Patients categorized as 'too late' for transplant or experiencing 'care escalation' within 30 days.

Main Results:

• 42% of Fontan patients experienced late referrals for advanced heart failure care.
• 10% were referred too late, with some dying within 30 days of consultation.
• 36% required care escalation, including VAD implantation or transplant listing.

Conclusions:

• A significant proportion of Fontan patients are referred late for advanced heart failure care.
• Late referral is strongly associated with heart failure occurring within one year of Fontan surgery.
• Earlier referral, particularly post-Fontan surgery, is recommended to improve patient outcomes.