Beyond Stage C: Considerations in the Management of Patients With Heart Failure Progression and Gaps in Evidence

J Card Fail. 2023 May;29(5):818-831. doi: 10.1016/j.cardfail.2023.02.015. Epub 2023 Mar 22.

Abstract

Despite treatment with contemporary medical therapies for chronic heart failure (HF), there has been an increase in the prevalence of patients progressing to more advanced disease. Patients progressing to and living at the interface of severe stage C and stage D HF are underrepresented in clinical trials, and there is a lack of high-quality evidence to guide clinical decision making. For patients with severe HF phenotypes, the medical therapies used for patients with less advanced stages of illness are often no longer tolerated or provide inadequate clinical stability. The limited data on these patients highlights the need to increase formal research characterizing this high-risk population. This review summarizes existing clinical trial data and incorporates our considerations for approaches to the medical management of patients advanced "beyond stage C" HF.

Keywords: advanced heart failure; cardiogenic shock; heart transplantation; left ventricular assist device; mechanical circulatory support; palliative care.

Publication types

  • Review

MeSH terms

  • Chronic Disease
  • Heart Failure* / diagnosis
  • Heart Failure* / epidemiology
  • Heart Failure* / therapy
  • Heart-Assist Devices*
  • Humans
  • Risk Factors