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J Card Fail. 2015 Jun;21(6):519-34. doi: 10.1016/j.cardfail.2015.04.013. Epub 2015 May 4.

Advanced (stage D) heart failure: a statement from the Heart Failure Society of America Guidelines Committee.

Author information

1
Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah.
2
Washington University School of Medicine, St. Louis, Missouri.
3
University of Colorado School of Medicine, Aurora, Colorado.
4
Stony Brook Heart Institute, Stony Brook University School of Medicine, Stony Brook, New York.
5
School of Nursing, Azusa Pacific University, Azusa, California.
6
University of Michigan, Ann Arbor, Michigan.
7
Spectrum Health, Grand Rapids, Michigan.
8
Wayne State University, Detroit, Michigan.
9
Department of Clinical Research, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina.
10
Sarver Heart Center, University of Arizona, Tucson, Arizona.
11
San Francisco Veterans Affairs Medical Center and University of California San Francisco, San Francisco, California.
12
Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania.
13
Nursing Institute and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
14
Advanced Cardiovascular Institute, Middletown, Ohio.
15
The Care Group, Indianapolis, Indiana.
16
University of Toledo, Toledo, Ohio.
17
Georgetown University and Washington DC Veterans Affairs Medical Center, Washington, DC.
18
University of Alberta, Alberta, Edmonton, Canada.
19
Temple Heart and Vascular Institute, Temple University Hospital, Philadelphia, Pennsylvania.
20
Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
21
The Ohio State University, Columbus, Ohio.
22
Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York.
23
Massachusetts General Hospital, Boston, Massachusetts.
24
University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina.
25
Tufts Medical Center, Boston, Massachusetts.
26
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: mgivertz@partners.org.

Abstract

We propose that stage D advanced heart failure be defined as the presence of progressive and/or persistent severe signs and symptoms of heart failure despite optimized medical, surgical, and device therapy. Importantly, the progressive decline should be primarily driven by the heart failure syndrome. Formally defining advanced heart failure and specifying when medical and device therapies have failed is challenging, but signs and symptoms, hemodynamics, exercise testing, biomarkers, and risk prediction models are useful in this process. Identification of patients in stage D is a clinically important task because treatments are inherently limited, morbidity is typically progressive, and survival is often short. Age, frailty, and psychosocial issues affect both outcomes and selection of therapy for stage D patients. Heart transplant and mechanical circulatory support devices are potential treatment options in select patients. In addition to considering indications, contraindications, clinical status, and comorbidities, treatment selection for stage D patients involves incorporating the patient's wishes for survival versus quality of life, and palliative and hospice care should be integrated into care plans. More research is needed to determine optimal strategies for patient selection and medical decision making, with the ultimate goal of improving clinical and patient centered outcomes in patients with stage D heart failure.

KEYWORDS:

Heart failure; advanced; stage D

PMID:
25953697
DOI:
10.1016/j.cardfail.2015.04.013
[Indexed for MEDLINE]

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