Criteria for advanced chronic heart failure:
(1) NYHA functional class III or IV
(2) episodes of fluid retention and/or peripheral hypoperfusion at rest
(3) one or more manifestations of severe cardiac dysfunction:
(3a) LVEF < 30%
(3b) a severe abnormality of cardiac function on Doppler echocardiography with a pseudonormal or restrictive mitral inflow pattern
(3c) high left ventricular filling pressures
(3d) elevated serum BNP or pro-BNP in the absence of non-cardiac explanations
(4) one or more findings indicative of severe impairment of functional capacity:
(4a) inability to exercise
(4b) 6 minute walking test (6MWT) less than 300 meters (a lower threshold may be used on females or patients >= 75 years)
(4c) peak VO2 < 12 mL per kg per min (some may use < 14 mL per kg per min)
(5) history of one or more hospitalizations for heart failure in the past 6 months
(6) symptomatic despite optimized therapy
where:
• NYHA class III or IV is associated with severe symptoms of heart failure with dyspnea and/or fatigue at rest or after minimal exertion.
• Episodes of fluid retention may include pulmonary edema, peripheral edema or systemic congestion.
• High left ventricular filling pressures are indicated by PCWP > 16 mm Hg and/or mean right atrial pressure > 12 mm Hg by pulmonary artery catheterisation
• Optimized therapy may include use of diuretics, inhibitors of the renin-angiotensin-aldosterone system, beta-blockers and cardiac resynchronisation therapy (CRT).
