50
Treatment
Table 18. Clinical Indicators of Advanced HF
Repeated hospitalizations or emergency department visits for HF in the past 12 mo.
Need for intravenous inotropic therapy.
Persistent NYHA functional class III to IV symptoms despite therapy.
Severely reduced exercise capacity (peak VO
2
, <14 mL/kg/min or <50% predicted,
6-minute walk test distance <300 m, or inability to walk 1 block on level ground
because of dyspnea or fatigue).
Intolerance to RAAS inhibitors because of hypotension or worsening renal function.
Intolerance to beta blockers as a result of worsening HF or hypotension.
Recent need to escalate diuretics to maintain volume status, oen reaching daily
furosemide equivalent dose >160 mg/d or use of supplemental metolazone therapy.
Refractory clinical congestion.
Progressive deterioration in renal or hepatic function.
Worsening right HF or secondary pulmonary hypertension.
Frequent SBP ≤90 mm Hg.
Cardiac cachexia.
Persistent hyponatremia (serum sodium, <134 mEq/L).
Refractory or recurrent ventricular arrhythmias; frequent ICD shocks.
Increased predicted 1-year mortality (e.g., >20%) according to HF survival models
(e.g., MAGGIC, SHFM).
8.2. Nonpharmacological Management: Advanced HF
COR LOE
Recommendation
2b C-LD 1. For patients with advanced HF and hyponatremia, the
benefit of fluid restriction to reduce congestive symptoms is
uncertain.
