Russell et al identified a number of clinical findings associated with advanced heart failure. The authors are from Johns Hopkins Hospitals in Baltimore, Maryland.

Clinical findings associated with advanced heart failure:

(1) frequent implantable cardioverter-defibrillator (ICD) shocks

(2) progressive decline in the serum sodium concentration, typically < 133 mmol/L

(3) inability to walk 1 block on level ground because of fatigue and/or dyspnea

(4) persistent dyspnea during bathing and/or dressing, with need for rest

(5) systolic blood pressure < 90 mm Hg frequently

(6) worsening heart failure or hypotension while taking a beta blocker

(7) worsening renal function or hypotension while taking an angiotensin converting enzyme (ACE) inhibitor

(8) weight loss unexplained by other cause (cardiac cachexia)

(9) progressive deterioration in renal function (progressive increase in serum concentrations of BUN and creatinine) not explained by another cause

(10) repeated Emergency Room visits or hospitalizations in the past year (>= 2)

(11) recent need to increase diuretic dose in order to maintain volume status (daily furosemide equivalent dose > 160 mg and/or supplemental metolazone therapy)

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