There are 65 million adults in US who have heart failure. Prevalence of HF is 1.8% in India. It is extremely important to identify patients with advanced heart failure who are not getting better with medications and need therapies like Mechanical Circulatory Support and/or HeartTransplantation. These patients need to be seen in a HF clinic where they can be followed closely and be assessed for advanced HF therapies mentioned above.

When is the time to refer-

1. Multiple or recurrent admissions to hospital for heart failure

2. Heart, ejection fraction less than 35%

3. Kidney/liver dysfunction

4. Unable to take medications due to low blood pressure

5. Having Shortness of breath on doing regular activities despite taking appropriate medications

6. Receiving recurrent shocks from the defibrillator

Once a patient who has one or more features listed above, an extensive and comprehensive evaluation is done to assess if that patient is a candidate for MCS or heart transplant. These decisions are taken by a multidisciplinary team which consists of cardiac surgeon, Heart Failure cardiologist, a cardiac anesthesiologist and several consultants whose opinion is sought.

It is extremely important to refer these patients at the right time before they get too sick and not candidates for above mentioned therapeutic options.

Dr Sandeep Attawar

MBBS, MS (Gen. Surgery), MCh (Cardiac Surgery)

Founder Director & Chair of Advanced Heart Failure,

Terminal Lung Disease &The Solid Thoracic Organ Transplant Program,

KIMS Institute of Heart, Lung Transplantation & Assist Devices.irector & Chair,

Institute of Heart-Lung Transplant, KIMS Hospitals, Sec-bad