Clinically-Based Tools for Maximum Patient Benefit

Guidelines for advanced heart failure management continue to evolve as technologies and outcomes improve. Today, recommendations for advanced heart failure therapy are based on three decades of clinical experience. Simple patient referral indicators provide physicians with a defined tool for identifying patients appropriate for ventricular assist device (VAD)/transplant evaluation.⁸ Age is not a contraindication for MCS, as it can be for cardiac transplantation. Moreover, smaller, more reliable VADs can now improve the duration and quality of life for patients of virtually any size.*

Patient Referral Criteria⁸

Patients with more than one of the following risk factors and who are New York Heart Association (NYHA) Class III or IV should be considered for referral for mechanical circulatory support (MCS) and/or cardiac transplantation evaluation.

Functional Assessment

• Inability to walk one block without shortness of breath
• Intolerant or refractory to ACE inhibitors, angiotensin receptor blockers, or beta-blockers
• One heart-failure–related hospital admission in the past 6 months³⁰
• CRT nonresponder
• High diuretic dose (e.g., 120 mg/d furosemide)

Lab Assessment

• Serum sodium < 136 mmol/L
• BUN > 40 mg/dL or serum creatinine > 1.8 mg/dL
• Hematocrit < 35%

*The safety and effectiveness of Thoratec VADs in pediatric population has not been established.

Mechanical Circulatory Support Candidate Selection Algorithm¹⁰

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