LAUSR

Although heart transplantation (HT) and the implantation of a left ventricular assist device (LVAD) both provide clear benefits with respect to the natural history of advanced heart failure (HF), with 1-year survival rates of around 80–90%,1,2 many have had the impression that these advanced therapies are often underused – not just because of short supply or cost, but because of short demand, i.e. failure to refer suitable patients. This notion is supported by the fact that the frequency with which these therapies are employed varies not only from country to country3 (Figure 1) but also among different regions of the same country, even when no causative significant differences in supply or cost are to be expected. For example, among the 17 Spanish autonomous communities, those two with the lowest HT rates do not have their own HT programmes (HT patients are referred to other communities), which suggests that the low rates may in part be due to a tendency to overlook the possibility of HT.4 Of course, it is also true that, for a number of reasons, including the subjectivity of many partial criteria of advanced HF, it is often difficult to detect whether a ‘stable HF’ patient is eligible for HT or LVAD implantation. In this issue of the Journal, Lund and colleagues report the results of the ScrEEning for advanced Heart Failure treatment (SEE-HF),5 a multicentre study in which a two-stage screening protocol was applied to patients with a cardiac resynchronization therapy (CRT) or implantable cardioverter defibrillator (ICD) device to detect those who were eligible for HT or LVAD implantation. Eight centres in seven European countries participated, all of which had an LVAD programme and six of the eight an HT programme. The criterion for passage from stage 1 to stage 2 of the screening protocol was that the patient was stable under optimal medical