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

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...

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Bibliographic Details
Published in:Diagnostics (Basel) 2019-11, Vol.9 (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: Article
Language:English
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
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Summary: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.
ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics9040170