52
Treatment
8.3. Inotropic Support
COR LOE
Recommendations
2a B-NR 1. In patients with advanced (stage D) HF refractory to GDMT
and device therapy who are eligible for and awaiting MCS
or cardiac transplantation, continuous intravenous inotropic
support is reasonable as "bridge therapy".
2b B-NR 2. In select patients with stage D HF, despite optimal GDMT
and device therapy who are ineligible for either MCS or
cardiac transplantation, continuous intravenous inotropic
support may be considered as palliative therapy for symptom
control and improvement in functional status.
3: Harm B-R 3. In patients with HF, long-term use of either continuous or
intermittent intravenous inotropic agents, for reasons other
than palliative care or as a bridge to advanced therapies, is
potentially harmful.
8.4. Mechanical Circulatory Support
COR LOE
Recommendations
1 A 1. In select patients with advanced HFrEF with NYHA class IV
symptoms who are deemed to be dependent on continuous
intravenous inotropes or temporary MCS, durable LVAD
implantation is effective to improve functional status, QOL,
and survival.
2a B-R 2. In select patients with advanced HFrEF who have NYHA
class IV symptoms despite GDMT, durable MCS can be
beneficial to improve symptoms, improve functional class, and
reduce mortality.
Value Statement:
Uncertain Value
(B-NR)
3. In patients with advanced HFrEF who have NYHA class IV
symptoms despite GDMT, durable MCS devices provide low
to intermediate economic value based on current costs and
outcomes.
2a B-NR 4. In patients with advanced HFrEF and hemodynamic
compromise and shock, temporary MCS, including
percutaneous and extracorporeal ventricular assist devices, are
reasonable as a "bridge to recovery" or "bridge to decision".
8.5. Cardiac Transplantation
COR LOE
Recommendations
1 C-LD 1. For selected patients with advanced HF despite GDMT,
cardiac transplantation is indicated to improve survival and
QOL.
Value Statement:
Intermediate Value
(C-LD)
2. In patients with stage D (advanced) HF despite GDMT,
cardiac transplantation provides intermediate economic value.
