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CHOICE - VAD Patient Selection and Referral

 

If your patient is persistently symptomatic and has one or more of the C.H.O.I.C.E. risk factors, they may be a candidate for VAD Therapy.

From the first consideration of an LVAD, emphasis should be placed on the anticipated differences between ongoing medical therapy and LVAD with respect to both survival and quality of life. These discussions should occur before consideration of continuous outpatient inotropic infusions for hemodynamic support of deteriorating clinical status.1

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C.H.O.I.C.E. Risk Factors

Symptoms to Watch for:

  • Shortness of breath on mild exertion/breathless at rest4
  • Low six-minute walk test distance (<300 m)2
  • Inability to perform an exercise test2
  • Inability to climb two flights of stairs
  • Inability to walk two blocks
  • Increased diuretic requirement2
  • Intolerance to neurohormonal antagonists2
    (ACEi/ARB/BB)
  • Hypotension2
  • CRT non-responder / not indicated5
  • Increasing plasma BNP or NT-proBNP levels despite adequate heart failure treatment6

C.H.O.I.C.E. Resources


References

  1. Miller, L. Is left ventricular assist device therapy underutilized in the treatment of heart failure? Circulation. 2011;123:1552-1558.
  2. Peura, J, et al. AHA. Recommendations for the use of mechanical circulatory support: device strategies and patient selection.2012;126:2653-2667.
  3. McMurray JJV, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J. 2012;33:1787-1847.
  4. Thorvaldsen, T, et al. Triage of patients with moderate to severe heart failure who should be referred to a heart failure center. J Am Coll Cardiol.2014;63:661-671.
  5. Daubert, J, et al. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: Implant and follow-up recommendations and management. Europace. 2012;14:1236-1286.
  6. Banner, N, et al. UK Guidelines for referral and assessment of adults for heart transplantation. Heart. 2011;97:1520-1527.

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