IMR Press / RCM / Volume 23 / Issue 2 / DOI: 10.31083/j.rcm2302048
Open Access Review
Advanced heart failure: state of the art and future directions
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1 Heart Failure Unit, Department of Cardiology, AORN dei Colli Monaldi Hospital, 80131 Naples, Italy
2 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA 90048, USA
3 Heart Transplant Unit, Department of Cardiac Surgery and Transplants, AORN dei Colli Monaldi Hospital, 80131 Naples, Italy
*Correspondence: (Daniele Masarone)
Academic Editors: Giuseppe Biondi-Zoccai, Mariangela Peruzzi and Antonio Abbate
Rev. Cardiovasc. Med. 2022, 23(2), 48;
Submitted: 8 December 2021 | Revised: 14 January 2022 | Accepted: 18 January 2022 | Published: 8 February 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Advanced heart failure is a clinical challenge that requires a pathophysiological-based approach. As the field has been the subject of multiple reviews, the objective of this paper is not to duplicate these publications but rather to offer practical tips for the clinical cardiologist to enable the optimal management of patients with advanced heart failure. Advanced heart failure is defined as a clinical syndrome characterized by severe and persistent symptoms, most commonly with severe ventricular dysfunction, despite optimized medical therapy. This review covers the management of the advanced heart failure patient from pharmacologic therapy with disease-modifying drugs, to the use of electrical therapy devices, percutaneous valve repair and finally to the role of left ventricular assist devices and heart transplantation. The review also explores future directions in the management of advanced heart failure, including translational perspectives for the treatment of this syndrome.

advanced heart failure
acutely decompensated heart failure
left ventricular assist device
HeartMate 3
heart transplant
Fig. 1.
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