Communication and Decision Making in Advanced Heart Disease

Part 1: Introduction

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What is Advanced Heart Failure?

Allen et al. Decision making in advanced HF. Circulation, 2012.


  • Moderate to severe symptoms of dyspnea and/or fatigue at rest with minimal exertion
  • Recurring episodes of fluid retention and/or reduced cardiac output

    Objective evidence of severe cardiac dysfunction
  • LV EF% < 30%
  • Restrictive mitral inflow patterns
  • High L or R ventricular filling pressures
  • Elevated BNP levels

    Severe impairment of functional capacity
  • 6MWD < 980 ft or Peak VO2 < 12-14 ml/kg/min

  • HF hospitalization in last 6 months
  • Despite optimal medical therapy