Clinical findings associated with advanced chronic heart failure:
(1) severe symptoms (NYHA Class III or IV, dyspnea and/or fatigue at rest or with minimal exertion)
(2) clinical episodes of peripheral hypoperfusion and/or fluid retention
(3) one or more of the following objective findings indicating severe cardiac dysfunction:
(3a) left ventricular ejection fraction (LVEF) < 30%
(3b) pseudonormal or restrictive mitral inflow pattern on Doppler echocardiography
(3c) high right and/or left ventricular filling pressures (right atrial pressure > 12 mm Hg and/or mean pulmonary capillary wedge pressure > 16 mm Hg)
(3d) elevated B-type natriuretic peptides (BNP or NT-proBNP) not explained by a noncardiac cause
(4) severe impairment of functional capacity with one or more of the following:
(4a) inability to exercise
(4b) 6-minute walk distance less than 300 meters
(4c) peak oxygen uptake (VO2) less than 12-14 mL per kg per min
(5) history of 2 or more hospitalizations for heart failure during the past 6 months
(6) presence of all of these features despite optimal therapy for the heart failure
