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

*geplaatst 2026-11-08 · Hartfalen · Giornale italiano di cardiologia (2006) · doi 10.1714/4793.48194 · https://hartvaat.nl/2026/11/01/regionaal-netwerk-voor-gevorderd-hartfalen-registreert-toename-vroege-verwijzing/*

Een prospectief regionaal register van 468 volwassen patiënten met gevorderd hartfalen in Toscane (2020-2025) analyseerde verwijscijfers en behandeltrajecten voor harttransplantatie (HTx) en LVAD-implantatie. Het aantal verwijzingen nam significant toe, met een verschuiving naar lichtere INTERMACS-profielen (6-7 steeg van 3,3% naar 20,9%), wat wijst op vroegtijdigere signalering. Van de 340 potentiële kandidaten onderging 61% een HTx en 6,2% een LVAD-implantatie. Deze verschuiving naar vroeger verwijzen bevestigt de werking van het regionale zorgpad en is cruciaal voor tijdige toegang tot geavanceerde therapieën en betere patiëntuitkomsten.

## English: [Regional network for advanced heart failure in Tuscany: analysis of referrals and patient pathways for heart transplantation and left ventricular assist device implantation (2020-2025)].

A regional register tracking 468 adults with advanced heart failure in Tuscany between 2020 and 2025 mapped referral volumes and care pathways for heart transplantation and LVAD support. Referrals rose significantly over the period, with a notable shift toward earlier INTERMACS profiles (group 6-7 increased from 3.3% to 20.9%), reflecting improved early detection. Among 340 patients deemed eligible for advanced therapies, 61% received a transplant and 6.2% were implanted with an LVAD. Earlier identification through this coordinated network is vital for optimizing patient selection and improving long-term survival in advanced heart failure.

## Abstract (original, from the publication)

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.

Auteurs: Adelina Selimi, Francesca Maria Righini, Carlotta Sorini Dini, Antonio Pagliaro, Luca Martini, Sonia Bernazzali, Chiara Lazzeri, Michela Maielli, Sandro Sponga, Giuseppe Davoli, Massimo Maccherini, Serafina Valente

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Bron: Giornale italiano di cardiologia (2006), https://doi.org/10.1714/4793.48194. Bijgewerkt 2026-11-01T02:28:25Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.