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Eur J Heart Fail. 2018 Nov;20(11):1505-1535. doi: 10.1002/ejhf.1236. Epub 2018 Jul 17.

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology.

Author information

1
Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC, La Coruña, Spain.
2
Cardiology, University of Brescia, Brescia, Italy.
3
Department of Medicine, Unit of Cardiology, Karolinska Institute, Stockholm, Sweden.
4
Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia.
5
Advocate Heart Institute, Naperville, IL, USA.
6
Athens University Hospital Attikon, Athens, Greece.
7
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
8
Transplant Unit, Royal Papworth Hospital, Cambridge, UK.
9
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
10
Transplant Center and De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy.
11
Department of Cardiology, Beirut Cardiac Institute, Beirut, Lebanon.
12
Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel.
13
Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
14
Department of Cardiology, Ege University Hospital, Izmir, Turkey.
15
Heart and Lung Transplant Program, Bologna University Hospital, Bologna, Italy.
16
Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany.
17
Heart Failure and Transplant Unit, Onassis Cardiac Surgery Centre, Athens, Greece.
18
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany.
19
Department of Cardiology of the Clinical Center of Serbia, Belgrade University School of Medicine, Belgrade, Serbia.
20
Department of Cardiology, University of Medical Sciences, Poznań, Poland.
21
Department of Cardiology, King's College Hospital, London, UK.
22
Department of Internal Medicine, Belgrade University School of Medicine and Heart Failure Center, Belgrade University Medical Center, Belgrade, Serbia.
23
University Heart Center, University Hospital Zurich, Zurich, Switzerland.

Abstract

This article updates the Heart Failure Association of the European Society of Cardiology (ESC) 2007 classification of advanced heart failure and describes new diagnostic and treatment options for these patients. Recognizing the patient with advanced heart failure is critical to facilitate timely referral to advanced heart failure centres. Unplanned visits for heart failure decompensation, malignant arrhythmias, co-morbidities, and the 2016 ESC guidelines criteria for the diagnosis of heart failure with preserved ejection fraction are included in this updated definition. Standard treatment is, by definition, insufficient in these patients. Inotropic therapy may be used as a bridge strategy, but it is only a palliative measure when used on its own, because of the lack of outcomes data. Major progress has occurred with short-term mechanical circulatory support devices for immediate management of cardiogenic shock and long-term mechanical circulatory support for either a bridge to transplantation or as destination therapy. Heart transplantation remains the treatment of choice for patients without contraindications. Some patients will not be candidates for advanced heart failure therapies. For these patients, who are often elderly with multiple co-morbidities, management of advanced heart failure to reduce symptoms and improve quality of life should be emphasized. Robust evidence from prospective studies is lacking for most therapies for advanced heart failure. There is an urgent need to develop evidence-based treatment algorithms to prolong life when possible and in accordance with patient preferences, increase life quality, and reduce the burden of hospitalization in this vulnerable patient population.

KEYWORDS:

Extracorporeal membrane oxygenation; Heart failure; Heart transplantation; Heart-assist devices

PMID:
29806100
DOI:
10.1002/ejhf.1236

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