Urgent Heart Failure Clinic

Offering same-day or next-day appointments with an advanced practice provider for decompensated heart failure paitents.

703-776-2529 | urgentHF@inova.org

Congestive Heart Failure: When to Consult an Advanced Heart Failure Specialist 

Inova Heart and Vascular Institute has a team of specialists for the treatment of congestive heart failure – advanced heart failure and transplant cardiologists and cardiac surgeons. They work together in a multidisciplinary program to assist referring physicians in managing complex heart failure patients. The team performs prognostic testing to assess the status of each patient and determine appropriate therapies for consideration.

We provide physician-, nurse- and pharmacist-based optimal medical therapy for advanced heart failure patients. We also offer a breadth of investigational medications and devices when conventional medications are not enough. Many innovative solutions, such as remote, home-based monitoring using a pulmonary artery pressure sensor, are utilized to improve care.

In addition, our team offers advanced surgical interventions such as mechanical circulatory support with left ventricular assist devices (LVADs) to improve quality and quantity of life in patients with end-stage heart failure.

For instances where transplantation is appropriate, our team is the most experienced in the Washington, DC region. Inova performed the region's first heart transplant in 1986 and now performs approximately 20 to 25 heart transplants each year for patients with end-stage heart disease.

Ideally our team would see patients long before they require any advanced therapies or transplant services to establish baseline measures. That way, we can partner with the local cardiologist or primary care provider in determining when consideration should be given for next steps.

Criteria for Referral: "I NEED HELP" – Markers of Advanced Heart Failure

I – Inotropes Previous or on-going requirement for dobutamine, milrinone, dopamine, or levosimendan
N – NYHA class / Natriuretic peptides Persisting NYHA Class III or IV and/or persistently high BNP or NT-pro-BNP
E - End-Organ Dysfunction Worsening renal or liver dysfunction in the setting of heart failure
E – Ejection Fraction Very low ejection fraction < 20%
D – Defibrillator Shocks Recurrent appropriate defibrillator shocks
H - Hospitalizations More than 1 hospitalization with heart failure in the last 12 months
E – Edema / Escalating Diuretics Persisting fluid overload and/or increasing diuretic requirements
L – Low Blood Pressure Consistently low BP with systolic < 90 to 100 mm Hg
P – Prognostic Medication Inability to up-titrate (or need to decrease/cease) ACEI, ARBs, ARNIs, B-Blockers or MRAs

ACEI – angiotensin-converting enzyme inhibitor; ARBs – angiotensin receptor blockers; ARNI - angiotensin receptor neprilysin inhibitors; BNP – B type natriuretic peptide; MRAs – mineralocorticoid receptor antagonist