Management of Advanced Heart Failure Patients

  • Dominique Anwar
  • Asif Anwar


The incidence of heart failure (HF) patients in the USA is estimated to be around six million, with half a million new cases adding each year) [1, 2]. It is associated with high symptom burden, frequent hospital admissions, diminished quality of life, high costs, and remains the leading cause of death in the USA [3, 4]. It is expected that 70–80 % of patients younger than age 65 will die within 8 years of their HF diagnosis, despite the availability of new medical and surgical options [2]. The evolution of HF in patients is typically characterized by acute crises or exacerbations followed by periods of stability lasting for months or even years. However, these patients are 6–9 times more likely to die of sudden cardiac death than the general population [2]. Several tools are available to help assess the prognosis in advanced HF patients: some are single-item predictors (such as the B-type natriuretic peptide [5], maximal oxygen consumption [6], creatinine level [7], other multivariable models (such as the Seattle Heart Failure Score [7] and the Acute Decompensated Heart Failure National Registry (ADHERE)) [8]. Similarly multiple prognostic factors are associated with increased likelihood of death in advanced HF, especially when coexistent: frequent emergency department visits or hospitalizations, symptoms at rest, dependency in activities of daily living, weight loss ≥ 10 %, albumin 2.5 g/dL, ejection fraction < 20 %, symptomatic arrhythmia, prior cardiopulmonary resuscitation, prior syncope, and embolic stroke. However, even while using these algorithms and other tools, life expectancy remains difficult to predict in advanced HF [3], and this is probably one of the reasons why less than 12 % of these patients benefit from hospice care [4].


Palliative Care Implantable Cardioverter Defibrillator Left Ventricular Assist Device Acute Decompensated Heart Failure Advanced Heart Failure 
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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Section of General Internal Medicine and GeriatricsTulane University School of MedicineNew OrleansUSA
  2. 2.Heart and Vascular Institute, Department of MedicineTulane University School of MedicineNew OrleansUSA

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