Increasing Access: Reducing Referral Delay in Patients With Ambulatory Advanced HF.

Background: Referral to advanced heart failure care (AHFC) is advocated to ensure favorable outcomes, and it has been shown to improve prognosis and quality of life in patients at advanced stages of disease. Nevertheless, it may occur later than desired; the rate of eligible patients referred in a timely manner is unknown. We sought to describe the current state of referral for AHFC, highlight potential factors leading to delayed referral and discuss strategies to increase access to AHFC.

Methods and results: We performed electronic searches on Pubmed, EMBASE, Web of Science, and The Cochrane Library to identify studies describing referral patterns to advanced heart failure, patient and provider characteristics associated with increased or decreased referral, settings of care, and associated clinical outcomes. We then discuss possible reasons for referral delay, as well as potential avenues for research and directed intervention to reduce delay and improve patients' outcomes.

Conclusion: A referral delay currently exists for AHFC, driven by multiple factors, among them providers' misconceptions about the benefits of AHFC and the appropriate timing of referral, a lack of specialized providers, insufficient and unequal access to care across demographics, and patients' lack of awareness. Efforts to reduce these and other root causes are needed to improve referral rates and optimize outcomes for patients with HF.