[Advanced heart failure: definition, epidemiology, diagnosis and treatment]

Advanced heart failure represents the most severe and complex stage of a chronic and progressive clinical syndrome that remains one of the leading causes of morbidity and mortality in industrialized countries. A substantial proportion of patients progress to a condition characterized by persistent symptoms, recurrent episodes of decompensation, and marked functional impairment despite optimized medical therapy and the appropriate use of cardiac devices. This advanced stage is associated with a considerable clinical, healthcare, and economic burden, together with a profound negative impact on the quality of life of both patients and caregivers. Early recognition of advanced heart failure remains a major challenge in everyday clinical practice, partly due to the heterogeneity of clinical presentations. Consequently, increasing clinician awareness, establishing standardized diagnostic criteria, and implementing dedicated care pathways are essential to ensure timely identification and appropriate patient management. In this context, the present review aims to provide an updated overview of advanced heart failure, with a particular focus on diagnostic criteria, currently available therapeutic strategies, and the most effective organizational models for optimizing the care of this complex and high-risk patient population.