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Worsening versus advanced heart failure: Management and challenges
Alberto Palazzuoli1, Marco Giuseppe Del Buono2,3, Giulia La Vecchia3,4
1Cardiovascular Diseases Unit, Cardio-Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, Siena, Italy.
ESC Heart Failure
|October 4, 2025
Summary
Distinguishing worsening heart failure (WHF) from advanced heart failure (AdvHF) is crucial for effective patient care. Recognizing these distinct stages enables timely interventions to improve outcomes and manage disease progression.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Heart failure (HF) is a progressive condition with increasing symptom severity.
- Worsening HF (WHF) and advanced HF (AdvHF) represent distinct stages of HF progression.
- These stages have unique clinical features, therapeutic needs, and outcomes.
Purpose of the Study:
- To differentiate between WHF and AdvHF.
- To provide a framework for earlier, targeted interventions.
- To improve patient outcomes and guide future research.
Main Methods:
- Review of distinct natural histories of WHF and AdvHF.
- Analysis of clinical presentations and diagnostic markers.
- Exploration of haemodynamic profiles and treatment responses.
Main Results:
- WHF involves symptom exacerbation requiring intensified treatment, often reversible.
- AdvHF is characterized by severe dysfunction despite optimal management, indicating end-stage disease.
- Significant differences exist in haemodynamics, severity, and treatment response between WHF and AdvHF.
Conclusions:
- Recognizing the transition from WHF to AdvHF is pivotal for patient care.
- Standardized definitions and earlier identification of these phenotypes are essential.
- Targeted interventions can alter disease trajectory and prevent decline in advanced HF.
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