Metra et al listed practical criteria for advanced chronic heart failure (ACHF). A patient with ACHF has a poor prognosis with a compromised quality of life. The authors are from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology (ESC).


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


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