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Our experts can assist in managing complicated heart failure patients, including heart failure with reduced and preserved ejection fraction. A comprehensive review of patient history can provide further insight regarding etiologies, current and potential therapies for both anticipated and unanticipated events, disease trajectory/prognosis and advanced care planning.
When to Consider a Referral
Persistent NYHA functional class III-IV symptoms
Need for chronic IV inotropes
Worsening renal function
Inability to tolerate optimally-dosed neurohormonal blockade
Increasing diuretic requirements
Recurrent heart failure readmissions (>/= two in the last year)
CardioMEMS is a wireless monitoring system that consists of a tiny pressure sensing device inserted into a distal branch of the pulmonary artery (PA) during a right heart catheterization procedure. It communicates via an external pillow antenna that transmits the PA pressure reading to a secure website that can be immediately accessed by clinicians.
Pressure readings monitored at least twice a week by heart failure nurses
Medications titrated as necessary to manage pressure changes or other symptoms
Decreases the chance of heart failure hospitalization
When to Consider a CardioMEMS Referral
NYHA Class III (symptomatic) heart failure AND
Admission to the hospital for heart failure within the last year
Other clinical considerations:
eGFR>25 (small amount of contrast required for implant)
Antithrombotic therapy required after implant:
DAPT for 1 month and then aspirin indefinitely OR
Continue pre-existing therapeutic anticoagulation
Willing and able to transmit daily 18-second recordings via a non-invasive sensor
Access to a cellular, wifi, or landline phone connection
The CDAc provides same-day assessment and treatment by board certified cardiologists for patients with cardiac symptoms that are non-life threatening but require prompt attention. Appropriate patients can bypass the ED, but must be referred by a physician.
Urgent diagnostic testing including stress testing and echocardiography
Extended hours on weekdays (8 am –11 pm)
Overnight evaluation in an observation unit staffed 24 hours a day
Consider a CDAc referral if your patient presents with:
Volume overload without unstable vital signs or significant hypoxia (more than 2-3L nasal cannula requirement)
Additional considerations include:
Concern for malignant syncope
Anginal chest pain needing to be ruled out for MI (Please note: patients with ST elevations or unstable vital signs should go to the ED.)
Rapid, symptomatic atrial fibrillation
How to Refer
Speak directly with the cardiologist on duty and start your referral by calling 617-632-7777.
BIDMC's Advanced Heart Failure Program uses continuous flow ventricular assist devices (VADs), including Heartware and Heartmate 3, to improve survival and quality of life in patients with end stage heart failure. VADs can be used as a bridge to transplant (BTT) or destination therapy (DT) in those who cannot be listed for heart transplant.
When to Consider a Referral for a Durable VAD
Heart failure with reduced ejection fraction with NYHA class III-IV symptoms
Inability to tolerate guideline directed medical therapy
BIDMC offers a range of temporary mechanical circulatory support (MCS) devices to support single and biventricular failure. Available devices include intra-aortic balloon pump, Impella (CP, 5.0, RP), CentriMag, and extracorporal membrane oxygenation (ECMO). These devices support patients through acute critical illnesses as a bridge to recovery or to permanent therapies, such as durable ventricular assist device (VAD) or organ transplantation.
When to Consider a Temp MCS Referral
Typical candidates for temporary MCS have been admitted to an ICU or are receiving care in an emergency setting, cardiac catheterization laboratory or operating room. Patients should be considered for temporary MCS referral if they have:
In a close collaboration with BIDMC Interventional Cardiology and Echocardiography, BIDMC’s Advanced Heart Failure team evaluates patients with severe mitral regurgitation to determine whether patients are candidates to undergo a minimally invasive repair of the valve with the MitraClip. The MitraClip device is FDA-approved for this condition.
Since 2014, BIDMC has performed the most MitraClip procedures in the New England region.
Cardio-Oncology specialists manage cardiovascular disease during and after cancer treatment in collaboration with oncologists at BIDMC and the Dana Farber Cancer Institute. To refer your patient, email Cardio-Oncology@bidmc.harvard.edu.
Chronic Resynchronization Optimization Clinic
This clinic offers optimization of chronic resynchronization therapy using echocardiography and electrophysiology in patients with less than optimal response to CRT therapy. To refer your patient, email email@example.com.
Cardiac Amyloidosis Program
Heart failure specialists and cardio-oncologists manage patients with cardiac amyloidosis. Technetium Pyrophosphate (PYP) scanning, cardiac MRI, endomyocardial and bone marrow biopsies are available. To refer your patient, email HeartFailureReferrals@bidmc.harvard.edu.
Cardiac Sarcoid Center
Heart failure specialists, electrophysiologists, pulmonologists, and rheumatologists work together as a part of the BIDMC Cardiac Sarcoid Center to manage patients with cardiac sarcoidosis. Cardiac/pulmonary PET scans and cardiac MRI are available. To refer your patient, email us or call 617-667-8800.
Cardiopulmonary Exercise Testing
Level I & 3 CPET is available for patients with dyspnea due to heart failure and/or pulmonary disease. A Dyspnea Clinic is available to help decide the type of testing a patient may require as well as diagnose the cause of undifferentiated dyspnea. To refer your patient, email firstname.lastname@example.org.
Secondary Mitral Regurgitation: A New Target in Heart Failure
A. Reshad Garan, MD, Director of Advanced Heart Failure and Mechanical Circulatory Support at BIDMC, discussed secondary mitral regurgitation as a therapeutic target for heart failure patients.