© 2007 European Society of Cardiology
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
a Section of Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia, Italy
b Department of Cardiology, Military Hospital, Wroclaw, Poland
c Cardiology Division, University of Bergen, Stavanger University Hospital, Stavanger, Norway
d Department of Cardiology, Western Infirmary, Glasgow, UK
e Department of Cardiology, Ospedali Riuniti di Bergamo, Bergamo, Italy
f Department of Cardiology, Sahlgrenska University Hospital/Sahlgrenska, Göteborg, Sweden
g Department of Cardiology, Wales Heart Research Institute, University of Wales College of Medicine, Cardiff, UK
h Department of Cardiology, Programme Coördinator COACH, University Hospital Groningen, Groningen, The Netherlands
i Department of Cardiac Surgery, St. Luke's Hospital, Panorama Thessaloniki, Greece
j Swiss Cardiovascular Center Bern Head Heart Failure & Cardiac Transplant., University Hospital (Inselspital), Bern, Switzerland
k Innere Medizin III, Universitätskliniken des Saarlandes, Homburg/Saar, Germany
l Applied Cachexia Research, Department of Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
m Clinical Cardiology, NHLI, Imperial College, London, UK
n Cardiac Department, Western Infirmary, Glasgow, Scotland UK
o Department of Cardiology, A.Z. Middellheim Hospital, Univ. of Antwerp, Antwerp, Belgium
p Département de Cardiologie, Pitié Salpêtrière Hospital, Paris Cedex 13, France
* Corresponding author. Section of Cardiovascular Diseases, c/o Cardiologia, Spedali Civili, P.zza Spedali Civili, 25123 Brescia, Italy. Tel: +39 030 3995572; fax: +39 030 3700359. E-mail address: metramarco{at}libero.it
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Abstract |
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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.
Key Words: Heart failure • Prognosis • Treatment
Received December 28, 2006; Revised March 5, 2007; Accepted April 18, 2007
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