Regionaal netwerk voor gevorderd hartfalen registreert toename vroege verwijzingen naar HTx en LVAD

BACKGROUND: Advanced heart failure requires regional care pathways capable of identifying patients before clinical deterioration prevents access to heart transplantation (HTx) or left ventricular assist device (LVAD) implantation. The available data mainly describe patients who have already been selected for, or treated with, advanced therapies, whereas analyses of the entire referral are less frequent. The aim of this study was to describe referral volume, clinical characteristics, and outcomes of patients referred to the Tuscany regional center for evaluation for HTx and/or LVAD implantation in the period 2020-2025, with specific attention to temporal referral trends and distribution of INTERMACS profiles. METHODS: Prospective observational registry including 468 consecutive adult patients referred to the regional reference center between January 2020 and December 2025. INTERMACS profile was assigned during the initial assessment. Candidacy for advanced therapies, pathway status of eligible patients, and temporal trend in INTERMACS groups 1-3, 4-5, and 6-7 were analyzed. RESULTS: During the observation period, a significant increase in referral volume between 2020-2022 and 2023-2025 was observed (incidence rate ratio 1.46; 95% confidence interval 1.22-1.76; p<0.001). The distribution of aggregated INTERMACS profiles changed over time, with an increase in profiles 6-7 from 3.3% to 20.9% and a reduction in profiles 4-5. Overall, 340 patients (72.6%) were potentially eligible for advanced therapies. Of these, 144 patients, corresponding to 30.8% of the entire cohort, were considered candidates for HTx and/or LVAD. Of these, 123 (36.2%) were listed for HTx, including 5 patients with LVAD support as bridge to transplant. Among listed patients, 75 (61.0%) underwent transplantation, 46 (37.4%) remained on the active waiting list, and 2 (1.6%) died while on the waiting list. Twenty patients underwent LVAD implantation as destination therapy and 1 patient as bridge to candidacy (21 patients in total, corresponding to 6.2% of eligible patients) and 130 eligible patients (38.2%) remained under follow-up. CONCLUSIONS: In this regional experience, the number of referrals to the reference center increased over time. The increasing representation of INTERMACS profiles 6-7, along with the reduction in profiles 4-5, is consistent with earlier patient management. These results demonstrate the consolidation of the regional network for advanced heart failure, but multicenter studies with systematic follow-up are needed to evaluate its impact on clinical outcomes.