Substantial variations in referrals for advanced heart failure therapies across UK and Ireland
No obvious link to geographical location or social deprivation to explain variations; Women less likely to be referred for life prolonging therapies than men
Substantial variations in referrals for advanced heart failure therapies are apparent across the UK and Ireland, with no obvious link to geographical location or social deprivation to explain the findings, reveals the first national audit of its kind, published online in the open access journal Open Heart.
Women are less likely to be referred for life prolonging therapies, such as a heart transplant or an implantable mechanical pump (left ventricular assist device or LVAD for short). They represent just 1 in 3 referrals, the audit shows.
Roughly one million people live with heart failure in the UK, with around 200,000 new cases diagnosed every year. Around 50,000 patients with advanced heart failure in the UK are under 65, making them potentially suitable for advanced therapies, note the researchers.
Yet only just over 300 surgical interventions for the condition at an advanced stage are carried out each year, they add.
Previous studies have shown variations in outcomes and referral patterns in patients with less advanced heart failure, but national access to advanced therapies hasn’t been evaluated before, they point out.
In 2024, the Transplant Cardiology Working Group carried out its first National Advanced Heart Failure Audit Report for the UK and Ireland, with the aim of improving the quality of care for patients with advanced heart failure.
The Working Group looked specifically at inpatient and outpatient referral patterns for heart transplants and LVADs to the 7 adult heart transplant centres across the UK and Ireland between January and April inclusive.
Referral regions were stratified by the number of referrals per million of the population, ranging from under 3 referrals/million to more than 9 referrals/million for 16 to 69 year olds, the eligible age range for a heart transplant.
Between the beginning of January and the end of April, 416 patients were referred for a heart transplant or LVAD assessment, equal to around 100 such referrals a month.
Their average age was 52; two thirds (67%) were male, and around 1 in 4 (27%) were of minority ethnic background.
Nearly 1 in 3 referred patients weren’t suitable for advanced therapies at the time of assessment, however, because of potentially modifiable contraindications. These included poorly controlled diabetes, tobacco and/or alcohol use, and frailty, suggesting missed opportunities for earlier identification and management of these factors before referral, say the researchers.
The average number of referrals/million age-eligible population ranged from 0 to to 30.
But after adjusting for age eligibility, referral rates varied significantly by region.
Neither distance to the nearest transplant centre nor the deprivation level of the patient’s postcode influenced referral likelihood, suggesting that factors such as clinician awareness or local referral culture may be driving this variation, explain the researchers.
Women were less likely to be referred for life prolonging treatment than men, representing just 1 in 3 such referrals.
The findings highlight a significant gap between need and provision of advanced heart failure care, say the researchers. And based on epidemiological estimates from other studies, around 134,000 people in the UK may be living with advanced heart failure, most of whom will need good specialist palliative care, they point out.
The researchers acknowledge various limitations to their findings, including the use of postcode areas, which may not perfectly capture socioeconomic circumstances, and the lack of information on the full care pathway.
Nevertheless, they suggest: “These findings…indicate a need for increased education, co-produced, standardised, referral criteria and broader service access working across national devolved healthcare boundaries.”
They add: “These data likely also reflect a lack of standardisation of [heart failure] specialist services across the UK, with good provision in some areas and poor or no provision in others.”
They conclude: “These findings have important implications for national healthcare planning, including workforce development and allocation of public health resources.
“Further work is required to investigate barriers to referral, enhance clinician awareness, and optimise care pathways for patients in need of both life-prolonging and supportive therapies.”
Dr Rajiv Sankaranarayanan, of the British Cardiovascular Society, which co-owns Open Heart, comments: “This first national audit of advanced heart failure referrals highlights striking inequities in access to life-prolonging therapies across the UK and Ireland. Particularly concerning is the under-representation of women, who accounted for only one third of referrals, despite comparable disease burden.
“Collectively, this work provides a powerful call to standardise referral pathways, improve equity of access, and strengthen advanced heart failure infrastructure nationally to ensure that potentially life-saving therapies are available to all suitable patients, irrespective of postcode or sex.”
Journal
Open Heart
Subject of Research
People
Article Title
Overview of findings from the UK and Ireland National Advanced Heart Failure Audit 2024
Article Publication Date
2-Jun-2026
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