Transition to Advanced Heart Failure: From Identification to Improving Prognosis

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Advanced heart failure (AHF) signifies the terminal stage of heart failure (HF), marked by persistent symptoms and functional decline despite guideline-directed medical therapy (GDMT).
• AHF is defined by severe symptoms (NYHA class III-IV), substantial cardiac dysfunction, and frequent hospitalizations, posing significant management challenges.

Purpose of the Study:

• To review the clinical definition, pathophysiology, and therapeutic strategies for advanced heart failure.
• To explore current limitations and future opportunities in AHF management.

Main Methods:

• Literature review of clinical definitions, pathophysiology, and therapeutic approaches for AHF.
• Analysis of pharmacological treatments, device-based interventions, heart transplantation, and palliative care.

Main Results:

• Key pathophysiological mechanisms include neurohormonal activation, ventricular remodeling, and systemic inflammation, leading to reduced cardiac output and organ dysfunction.
• Current therapeutic strategies involve a multidisciplinary approach, but limitations such as access disparities and the need for personalization persist.

Conclusions:

• Integrating innovative technologies, artificial intelligence, remote monitoring, personalized medicine, and palliative care is essential for improving outcomes in AHF.
• Early identification and timely intervention are critical for enhancing survival and functional status in patients with advanced heart failure.