(P008) GUIDELINE-REFERRAL CRITERIA AND RISK PROFILES OF OUTPATIENTS REFERRED TO A SPECIALIZED HEART FAILURE CLINIC

Background: Specialized heart failure (HF) care improves outcomes for patients with HF. To understand the risk profiles of HF outpatients referred to a specialized clinic, we evaluated referral reasons, predicted risk, and the presence of guideline-recommended referral criteria at a large specialized HF clinic.

METHODS AND RESULTS: We conducted a cross-sectional study including outpatients with HF (≥18 years) referred between November 2021-November 2022. To describe risk profiles, we calculated 1-year predicted mortality using the Seattle Heart Failure Model (SHFM) and the I-NEED-HELP referral criteria. We compared median SHFM-predicted mortality with referral reasons and the I-NEED-HELP criteria using Kruskal-Wallis, Wilcoxon rank-sum, chi-square, and Fisher's exact tests. Among 245 consecutive HF outpatients included, median SHFM-predicted 1-year mortality was 4% (25th-75th percentile: 2-8%). Reasons for referral included evaluation for advanced therapies (29%), medication optimization (23%), diagnostic evaluation (19%), post-hospitalization/emergency department visit (14%), ongoing HF management (12%), patient request (2%), and transition to adult care (1%). The median SHFM-predicted 1-year mortality did not differ significantly by referral reason (p=0.11) but differed significantly among patients meeting any (5%, 3-9%) vs no (3%, 2-5%) I-NEED-HELP criteria (p < 0.001). Across referral reasons, the presence of any I-NEED-HELP criteria differed significantly (p < 0.001); most patients referred for advanced therapies evaluation (96%) and diagnostic evaluation (94%) met at least one criterion.

Conclusion: Patients referred to a specialized HF clinic have a wide risk range. The difference in predicted mortality among patients meeting any vs no I-NEED-HELP criteria appears clinically insignificant. Incorporating model-predicted risk at the time of referral can guide triage and patient prioritization.