Advanced Heart Failure Referrals From Remote Australia: A Retrospective Study of Transplant Access From the Northern Territory

The Northern Territory (NT) does not have a transplant centre, requiring patients to travel interstate for assessment and treatment. We evaluated referral patterns and outcomes of patients from the Top End referred for advanced heart failure therapy. Methods We conducted a retrospective review of consecutive patients referred from Royal Darwin Hospital to interstate advanced heart failure services between 2016 and 2025. Demographics, Indigenous status, cardiomyopathy aetiology, left ventricular ejection fraction (EF) at presentation, referral dates and transplant outcomes were extracted from cardiology records. Time from referral to transplant centre multidisciplinary team (MDT) review was calculated. Results Nine of 18 patients referred for advanced heart failure therapy (50%) identified as Aboriginal or Torres Strait Islander. Twelve patients (67%) had non-ischaemic cardiomyopathy, four (22%) had ischaemic cardiomyopathy, and two (11%) had pulmonary arterial hypertension referred for lung transplantation. Median EF at presentation was 33%. Median time from referral to MDT review was 76 days (range 7–140 days). Patients must travel approximately 2,600–3,700 km interstate to access transplant services. Conclusions Patients with advanced heart failure in remote Australia face significant barriers to accessing transplantation.