Six scenarios for consultation with an advanced heart failure specialist

Heart failure affects a large, diverse patient population, and many diseases fall under its broad umbrella. These factors, together with ever-evolving guidelines for medical therapies and newly approved treatments hitting the market, make it difficult to pinpoint specific clinical criteria that warrant consultation with an advanced heart failure and transplant team.

“My rule of thumb is it’s never too early,” said Mitchell Psotka, MD, PhD, Section Chief, Heart Failure and Transplant at Inova Schar Heart and Vascular. “There are many scenarios when advanced heart failure physicians can be helpful in managing a heart failure patient. At Inova Schar Heart and Vascular, my advanced heart failure colleagues and I are happy to consult with cardiologists, even if it’s just a quick question over the phone. We want cardiologists to use us as a resource as they care for their patients with heart failure.”

Six times when an advanced heart failure physician can help

1. At diagnosis

Early on, advanced heart failure teams can identify the root cause of the patient’s heart failure including genetic causes of cardiomyopathy, and infiltrative diseases such as sarcoidosis, amyloidosis, or other conditions. Inova’s advanced heart failure team has the specialized experience and technology available to conduct all the investigations that are needed to uncover the “why” behind the disorder.

2. During the initial application of therapies

There are multiple therapies available that are known to improve heart function, reduce the risk of death and hospitalization, and make patients feel better. However, in the management of patients with heart failure, it can be difficult to schedule the high number of clinical touches that patients need to access these therapies. Inova’s team includes advanced practice providers who work with our physicians to give heart failure patients the close monitoring they need to begin these therapies.

3. When patients or providers want specialist involvement

“We do not want to take over the cardiology care for these patients,” Dr. Psotka said. “We’re happy to have early touches to assist with optimal care and then turn patients back to their regular cardiologists for ongoing care, followed by infrequent follow-ups as needed later on.”

4. When they see signs or markers of advanced heart failure

“The challenge tends to be identifying advanced heart failure early,” said advanced heart failure and transplant cardiologist Vanessa Blumer, MD. “Seeing any one marker would be a reason to refer a patient.”

Markers of advanced heart failure include:

• A patient with known heart failure who has had two or more heart failure hospitalizations in a year
• A patient is no longer able to tolerate guideline-directed medical therapy, despite having tolerated it in the past
• A patient with refractory congestion or someone who is volume overloaded, causing the provider to increase the patient’s diuretic dose
• A patient with ventricular tachycardia or ventricular arrhythmia who has a device and is now getting shocked by the device
• A patient who is on inotropic therapy

5. When patients need access to advanced therapies

Inova’s advanced heart failure program has access to therapies that otherwise would not be available to patients. They stretch beyond the well-known advanced therapies like LVADs and transplant and include Barostim™, cardiac optimizers, subspecialty medications such as immunosuppressors, specialty amyloid medications, and newly approved heart failure medications.

6. Anytime a cardiologist has a question about a heart failure patient

The advanced heart failure team at Inova enjoys consulting with cardiologists. Each of the doctors is happy to take calls from cardiology colleagues in the region. “It doesn’t have to be a formal referral. Quick questions are fine. We want it to be as easy as possible,” Dr. Psotka said.

Email us at HeartFailure@Inova.org and request a prompt call back from one of our physicians.

A phone conversation is all that’s needed for a cardiologist to refer a patient for evaluation. Inova’s team will facilitate everything else, whether it’s scheduling a time for a patient to come in or whether a question can be addressed by phone.

Inova’s advanced heart failure team has six outpatient office locations in addition to the inpatient services provided at Inova Fairfax, Inova Loudoun, and Inova Alexandria hospitals.

“Deciding to refer a patient early enough could save that patient’s life,” Dr. Blumer said.

Learn more about Inova’s Advanced Heart Failure Program.