The inaugural UK and Ireland National Advanced Heart Failure Audit 2024 found widespread potential inequity in access to advanced heart failure therapies, with significant regional variation in referral rates, under-referral of women, and a large gap between the ~200,000 annual new heart failure diagnoses and the ~325 heart transplant or LVAD procedures performed annually.
Key Findings
Background
There is a large gap between the number of new heart failure diagnoses and the number of advanced heart failure procedures performed annually in the UK.
Approximately one million individuals live with heart failure in the UK
Clinicians diagnose around 200,000 new cases of heart failure each year
Healthcare providers perform only about 325 heart transplantation (HTx) or left ventricular assist device (LVAD) procedures annually across the UK and Ireland
This gap suggests that many eligible patients do not receive appropriate referrals for HTx or LVAD
Results
The audit identified approximately 100 referrals per month for transplant or LVAD assessment across the seven adult heart transplant centres in the UK and Ireland.
This was the first international multicentre audit specifically examining referral patterns for HTx and LVAD therapies
Referrals were made to seven adult heart transplant centres across the UK and Ireland
The audit was conducted by the Transplant Cardiology Working Group
Results
Referral rates for advanced heart failure therapies varied significantly by region after adjusting for age eligibility.
Some areas showed high referral levels while others were substantially lower
Neither distance to the nearest transplant centre nor the deprivation level of the patient's postcode influenced referral likelihood
Factors such as clinician awareness or local referral culture may drive the observed variation
Results
Women are under-referred for advanced heart failure therapies, comprising only one in three patients assessed.
Women made up only one in three patients assessed for AHF therapies
This represents approximately 33% of referrals being female
The audit characterizes this as an important finding with implications for equity of access
Results
A considerable number of referred patients had contraindications to HTx or LVAD therapy.
The presence of contraindications among referred patients was identified as a notable audit finding
This finding suggests potential issues with the appropriateness of referrals or patient selection prior to referral
The audit did not specify the exact proportion of patients with contraindications in the abstract
Results
Neither geographic distance to the nearest transplant centre nor socioeconomic deprivation level of the patient's postcode influenced the likelihood of referral for advanced heart failure therapies.
Distance to the nearest transplant centre did not influence referral likelihood
Deprivation level of the patient's postcode did not influence referral likelihood
The authors suggest that clinician awareness or local referral culture may be the primary drivers of variation instead
Conclusions
The audit provides the first concrete evidence of widespread potential inequity in access to advanced heart failure therapies across the UK and Ireland.
This was described as 'the first international multicentre audit' of its kind
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
What This Means
This research examined how patients with severe heart failure are referred for life-saving treatments — specifically heart transplants and mechanical heart pumps called left ventricular assist devices (LVADs) — across the UK and Ireland. The study found a striking mismatch: while about 200,000 people are newly diagnosed with heart failure each year in the UK, only around 325 of these advanced procedures are performed annually. The audit tracked referrals to all seven specialist heart centres in the UK and Ireland and found about 100 referral assessments happening each month.
The research uncovered significant inequalities in who gets referred for these treatments. Women were notably under-represented, making up only about one in three patients assessed — despite heart failure affecting both sexes. Referral rates also varied considerably by region, but surprisingly, neither how far a patient lived from a specialist centre nor how deprived their neighbourhood was seemed to explain this variation. Instead, the authors suggest that differences in how aware local doctors are of these treatments, or the culture around making referrals in different areas, may be key factors driving the gaps.
This research matters because it is the first audit of its kind to systematically document that access to potentially life-prolonging heart failure treatments is unequal across the UK and Ireland. The findings suggest that many eligible patients may not be getting referred for treatments that could help them, not because of geography or poverty, but possibly because of differences in clinical practice and awareness. The authors call for further investigation into what prevents referrals, better education for clinicians, and improved care pathways to ensure patients who could benefit from these therapies are given the opportunity to be assessed.
Dar O, Dulay M, Pettit S, Bhagra S, Chue C, Payne J, et al.. (2026). Overview of findings from the UK and Ireland National Advanced Heart Failure Audit 2024.. Open heart. https://doi.org/10.1136/openhrt-2025-003909