Therapeutic options in advanced heart failure

Excerpt

Despite major advances in pharmacologic therapies for heart failure (HF) with impaired left ventricular function over the past decades, HF is still among the leading causes for recurrent hospitalizations and mortality. HF is a chronic, progressive and ultimately debilitating disease with a high morbidity and in advanced stages with an annual mortality above 50%. Furthermore, it shows a projected rise in prevalence in developed countries [1, 2]. A certain subset of HF patients will progress to develop symptoms that resemble the stage of advanced or “end-stage” heart failure which can be classified into stage D according to the current ACC/AHA guidelines. It is estimated that approximately 5% of all patients with HF can be classified into this advanced group [3]. Stage D HF patients generally show progressive or persistent, severe symptoms, recurrent decompensations attributed to the underlying cardiac dysfunction, despite optimal guideline-directed medical therapy (GDMT), surgical and/or device therapy. Further, morbidity is typically extensive and progressive and survival limited. Age, frailty, and psychosocial issues often negatively impact both outcomes and selection of therapy for these patients [4]. …