Why the study?
Referral indications for advanced heart failure care vary between centers, and many individuals with Fontan circulation die after late referral or without seeing a specialist.
Provides expert consensus recommendations for appropriately timed referral of individuals with Fontan circulation for advanced heart failure consultation.
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Establishes thresholds to guide timely advanced HF referrals in Fontan patients; extends expert consensus where prior guidance was limited.
Individuals with Fontan circulation are at risk of late mortality from both cardiac and noncardiac causes. Despite the known risk of mortality, referral indications for advanced heart failure care vary between centers, and many individuals die from Fontan circulation-related complications either after late consideration for advanced heart failure therapies or having never seen a heart failure specialist. There is a critical need for guidelines to direct appropriately timed referral for advanced heart failure consultation. The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) Fontan Committee has developed recommended thresholds for advanced heart failure referral to guide primary cardiologists. These recommendations are divided into 4 categories of clinical Fontan circulatory dysfunction including (1) cardiac/systemic ventricular dysfunction, (2) Fontan pathway dysfunction, (3) lymphatic dysfunction, and (4) extracardiac dysfunction.
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Lubert et al. (2023) studied this question. The ACTION Fontan Committee developed recommended thresholds for advanced heart failure referral in patients with Fontan circulation across four categories of circulatory dysfunction.
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