34
Treatment
Stage D
Table 21. European Society of Cardiology Definition of
Advanced HF
1. Severe symptoms of HF with dyspnea and/or fatigue at rest or with minimal
exertion (NYHA class III or IV)
2. Episodes of fluid retention (pulmonary and/or systemic congestion, peripheral
edema) and/or reduced cardiac output at rest (peripheral hypoperfusion)
3. Objective evidence of severe cardiac dysfunction shown by >1 of the following :
a. LVEF <30%
b. Pseudonormal or restrictive mitral inflow pattern
c. Mean PCWP >16 mm Hg and/or RAP >12 mm Hg by pulmonary artery
catheterization
d. High BNP or NT-proBNP plasma levels in the absence of noncardiac causes
4. Severe impairment of functional capacity shown by 1 of the following :
a. Inability to exercise
b. 6-Minute walk distance ≤300 m
c. Peak VO
2
<12 to 14 mL/kg/min
5. History of ≥1 HF hospitalization in past 6 months
6. Presence of all the previous features despite "attempts to optimize" therapy,
including diuretics and GDMT, unless these are poorly tolerated or
contraindicated, and CRT when indicated
Adapted from Metra M, et al; Heart Failure Association of the European Society of Cardiolog y.
Eur J Heart Fail. 2007;9:684-694.
