title: Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology.
abstract: Therapy has improved the survival of heart failure (HF) patients. However, many patients progress to advanced chronic HF (ACHF). We propose a practical clinical definition and describe the characteristics of this condition. Patients that are generally recognised as ACHF often exhibit the following characteristics: 1) severe symptoms (NYHA class III to IV); 2) episodes with clinical signs of fluid retention and/or peripheral hypoperfusion; 3) objective evidence of severe cardiac dysfunction, shown by at least one of the following: left ventricular ejection fraction<30%, pseudonormal or restrictive mitral inflow pattern at Doppler-echocardiography; high left and/or right ventricular filling pressures; elevated B-type natriuretic peptides; 4) severe impairment of functional capacity demonstrated by either inability to exercise, a 6-minute walk test distance<300 m or a peak oxygen uptake<12-14 ml/kg/min; 5) history of >1 HF hospitalisation in the past 6 months; 6) presence of all the previous features despite optimal therapy. This definition identifies a group of patients with compromised quality of life, poor prognosis, and a high risk of clinical events. These patients deserve effective therapeutic options and should be potential targets for future clinical research initiatives.
authors.affiliation: Section of Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia, Italy. metramarco@libero.it <metramarco@libero.it>
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Kenneth
authors.initials: K
authors.lastname: Dickstein
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Antonello
authors.initials: A
authors.lastname: Gavazzi
authors.forename: Claes-Hakan
authors.initials: CH
authors.lastname: Bergh
authors.forename: Alan G
authors.initials: AG
authors.lastname: Fraser
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.forename: Antonis
authors.initials: A
authors.lastname: Pitsis
authors.forename: Paul
authors.initials: P
authors.lastname: Mohacsi
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Stefan
authors.initials: S
authors.lastname: Anker
authors.forename: Henry
authors.initials: H
authors.lastname: Dargie
authors.forename: Dirk
authors.initials: D
authors.lastname: Brutsaert
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
mesh_terms: D002908:Chronic Disease; D003131:Combined Modality Therapy; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006801:Humans; D011379:Prognosis; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000628:therapy