162 advanced heart failure multi-disciplinary audit identifies patients who could benefit from transplantation & devices

Introduction Patients at high risk of deterioration who may benefit from transplantation can be identified using NT-pro-BNP and clinical characteristics. As a result of NHS England funding, NT-pro-BNP assay was funded for the first time which allowed patients to be offered screening. In addition, for the first time a joint MDT was offered by our local transplant centre. Methods We reviewed all outpatients who were under age 65 who had been seen at any time by our heart function service. We invited all patients to have a NT-pro-BNP measured by posting out a lithium heparin tube alongside an electronic phlebotomy request. Patient's cases were discussed at the MDT if NT-pro-BNP was greater than 1000 pg/ml, had ICD shocks, low blood pressure, recurrent hospitalisations, or difficulty with hypotension (I need help criteria). Medications, device therapy, advanced care planning and advanced heart failure therapy options were reviewed in conjunction with co-morbidities which would preclude transplantation. Results 420 patients were under the age of 65. 180 had left ventricular ejection fraction < 35%, 37 had defibrillators, and 19 had cardiac resynchronisation therapy. 270 patients had NT-pro-BNP sampling, 61 had a NT-pro-BNP >1000 pg/ml. 2 patients had left ventricular assist devices already implanted. After the audit & MDTs, 13 patients were identified who might benefit from defibrillators or device therapy, 8 patients were not fit for transplantation and 2 were referred to palliative care. 6 patients were judged to be appropriate for referral for evaluation for cardiac transplantation. Medication changes were also made. Conclusions A systematic audit of all patients under the age of 65 identified a cohort of patients who were at risk of deteriorating. These patients could benefit from life prolonging therapy or advanced care planning. Conflict of Interest none