Baumwol et al reported the "I Need Help" mnemonic to help to identify a patient with advanced heart failure who may need referral for an advanced therapy. This can help to reduce the problem of late referral. The authors are from Fiona Stanley Hospital in Australia
Patient selection: heart failure
Markers:
(1) Inotrope (dobutamine, milrinone, dopamine, etc) requirement
(2) NYHA class III or IV, or Natriuretic peptide persistently high
(3) End-organ dysfunction (liver, kidney)
(4) Ejection fraction less than 20%
(5) Defbrillator shocks recurrent and appropriate
(6) Hospitalized more than once for heart failure in the past 12 months
(7) Edema or need for Escalating diuretics
(8) Low blood pressure with systolic blood pressure less than 90 mm Hg
(9) Prognostic (? Problematic) medications, with inability to up-titrate drugs or need to discontinue ACEI, beta-blocker, ARNI's or MRA's
If one ore more of these markers is positive, then the patient should be referred.
