Advanced Heart Failure Patient LVAD Referral
If your patient experiences any of the following, refer them to a heart failure specialist for evaluation for advanced heart failure therapies, including LVAD therapy.1
High-Risk Clinical Triggers
IV inotropes
NYHA IIIB/IV or persistently elevated natriuretic peptides
End-organ dysfunction (Cr > 1.8 mg/dL or BUN > 43 mg/dL)
EF ≤ 35%
Defibrillator shocks
Hospitalizations > 1 with heart failure
Edema despite escalating diuretics
Low blood pressure, high heart rate
Prognostic medication — progressive intolerance or down-titration GDMT
Additional Considerations for LVAD Referral:
- CRT non-responder3
- Physical activity limited or impaired QOL4
Find out how your advanced heart failure patients can benefit from the HeartMate 3 LVAD.
HeartMate 3 LVAD Indication
The HeartMate 3™ Left Ventricular Assist System is indicated for providing short- and long-term mechanical circulatory support (e.g., as bridge to transplant or myocardial recovery, or destination therapy) in adult and pediatric patients with advanced refractory left ventricular heart failure and with an appropriate body surface area.
Patient Profile
- NYHA Class IIIB or IV
- Heart failure hospitalization(s)
- Unresponsive to diruetics5
Additional Considerations3
- Ejection Fraction < 40%
- Persistently high PA pressures
- Elevated Pro-BNP or BNP
- 6-Minute Walking Distance (6MWD) < 300m
Advanced Heart Failure Patient Workup
Evaluating a heart failure patient for advanced therapies requires the integration of clinical, imaging, hemodynamic, functional and biomarker data.
The following tests and patient information may be needed when referring a patient for advanced heart failure evaluation and LVAD therapy.7
- Physical examination
- Blood tests
- Chest x-rays
- Electrocardiogram (EKG or ECG)
- Echocardiography (abbreviated as "echo")
- Exercise stress test
- Radionuclide ventriculography or multiple-gated acquisition scanning (abbreviated as MUGA)
- Cardiac catheterization
- Magnetic resonance imaging (MRI)
- 6-Minute Walk Test8
Referring Advanced Heart Failure Patients for LVAD Evaluation
When you refer your advanced heart failure patients to a HeartMate LVAD implant center, you can reassure them that:
- They will undergo a complete and thorough evaluation to determine if they are a candidate for advanced therapies, including LVAD therapy.
- Both they and their caregivers will receive additional details of the surgery. They’ll also have the opportunity to ask questions about the procedure, recovery, and living with their HeartMate 3 LVAD.
- They can connect with a HeartMate 3 LVAD Patient Ambassador. Ambassadors are HeartMate 3 recipients who can speak with your patients about their experiences with a HeartMate LVAD.
References
- Writing Committee, Maddox TM, Januzzi JL Jr, Allen LA, et al. 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021;77(6):772-810. doi:10.1016/j.jacc.2020.11.022.
- Krishnamurthy Y, Cooper LB, Parikh KS, et al. Pulmonary Hypertension in the Era of Mechanical Circulatory Support. ASAIO J. 2016;62(5):505-512. doi:10.1097/MAT.0000000000000408
- Thorvaldsen T, Lund LH. Focusing on referral rather than selection for advanced heart failure therapies. Card Fail Rev. 2019;5(1):24-26. doi:10.15420/cfr.2018.35.1
- Morris AA, Khazanie P, Drazner MH, et al. Guidance for timely and appropriate referral of patients with advanced heart failure: a scientific statement from the American Heart Association. Circulation. 2021;144(15):e238-e250. doi:10.1161/CIR.0000000000001016
- Shams E, Bonnice S, Mayrovitz HN. Diuretic Resistance Associated With Heart Failure. Cureus. 2022;14(1):e21369. Published 2022 Jan 18. doi:10.7759/cureus.21369
- Current and Future Challenges in Mechanical Circulatory Support. Mehra, Mandeep R. Journal of Cardiac Failure, Volume 28, 5-6
- American Heart Association. Common Tests for Heart Failure. https://www.heart.org/en/health-topics/heart-failure/diagnosing heart-failure/common-tests-for-heart-failure. Accessed May 21, 2025.
- Giannitsi S, Bougiakli M, Bechlioulis A, et al. 6- minute walking test: a useful tool in the management of heart failure patients. Ther Adv Cardiovasc Dis. 2019;13:1-10.
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