Advanced Heart Failure and End-Stage Heart Failure: Does a Difference Exist

• Published in: Diagnostics (Basel) Vol. 9; no. 4; p. 170
• Main Authors: Severino, Paolo, Mather, Paul J, Pucci, Mariateresa, D'Amato, Andrea, Mariani, Marco Valerio, Infusino, Fabio, Birtolo, Lucia Ilaria, Maestrini, Viviana, Mancone, Massimo, Fedele, Francesco
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.11.2019; MDPI
• Subjects: advanced heart failure; Cardiovascular disease; Classification; Dyspnea; end stage heart failure; Epidemics; Exercise; Heart failure; Heart transplants; hlm classification; Hospitalization; Intervention; Life expectancy; Medical prognosis; Mortality; orthotopic heart transplant; Patients; Physical fitness; Population; Quality of life; Review; ventricular assist device; Canada; United States > US; Europe; ventricular assist device; HLM classification; advanced heart failure; end stage heart failure; orthotopic heart transplant
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics9040170

Advanced heart failure (AdHF) represents a challenging aspect of heart failure patients. Because of worsening clinical symptoms, high rates of re-hospitalization and mortality, AdHF represents an unstable condition where standard treatments are inadequate and additional interventions must be applied. A heart transplant is considered the optimal therapy for AdHF, but the great problem linked to the scarcity of organs and long waiting lists have led to the use of mechanical circulatory support with ventricular-assist device (VAD) as a destination therapy. VAD placement improves the prognosis, functional status, and quality of life of AdHF patients, with high rates of survival at 1 year, similar to transplant. However, the key element is to select the right patient at the right moment. The complete assessment must include a careful clinical evaluation, but also take into account psychosocial factors that are of crucial importance in the out-of-hospital management. It is important to distinguish between AdHF and end-stage HF, for which advanced therapy interventions would be unreasonable due to severe and irreversible organ damage and, instead, palliative care should be preferred to improve quality of life and relief of suffering. The correct selection of patients represents a great issue to solve, both ethically and economically.