Advanced (stage D) heart failure: A statement from the heart failure society of america guidelines committee

James C. Fang, Gregory A. Ewald, Larry A. Allen, Javed Butler, Cheryl A. Westlake Canary, Monica Colvin-Adams, Michael G. Dickinson, Phillip Levy, Wendy Gattis Stough, Nancy K Sweitzer, John R. Teerlink, David J. Whellan, Nancy M. Albert, Rajan Krishnamani, Michael W. Rich, Mary N. Walsh, Mark R. Bonnell, Peter E. Carson, Michael C. Chan, Daniel L. DriesAdrian F. Hernandez, Ray E. Hershberger, Stuart D. Katz, Stephanie Moore, Jo E. Rodgers, Joseph G. Rogers, Amanda R. Vest, Michael M. Givertz

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

We propose that stage D advanced heart failure be defined as the presence of progressive and/or persistent severe signs and symptoms of heart failure despite optimized medical, surgical, and device therapy. Importantly, the progressive decline should be primarily driven by the heart failure syndrome. Formally defining advanced heart failure and specifying when medical and device therapies have failed is challenging, but signs and symptoms, hemodynamics, exercise testing, biomarkers, and risk prediction models are useful in this process. Identification of patients in stage D is a clinically important task because treatments are inherently limited, morbidity is typically progressive, and survival is often short. Age, frailty, and psychosocial issues affect both outcomes and selection of therapy for stage D patients. Heart transplant and mechanical circulatory support devices are potential treatment options in select patients. In addition to considering indications, contraindications, clinical status, and comorbidities, treatment selection for stage D patients involves incorporating the patient's wishes for survival versus quality of life, and palliative and hospice care should be integrated into care plans. More research is needed to determine optimal strategies for patient selection and medical decision making, with the ultimate goal of improving clinical and patient centered outcomes in patients with stage D heart failure.

Original languageEnglish (US)
Pages (from-to)519-534
Number of pages16
JournalJournal of Cardiac Failure
Volume21
Issue number6
DOIs
StatePublished - Jun 1 2015

Fingerprint

Heart Failure
Guidelines
Equipment and Supplies
Signs and Symptoms
Therapeutics
Hospice Care
Survival
Palliative Care
Patient Selection
Comorbidity
Biomarkers
Hemodynamics
Quality of Life
Exercise
Morbidity
Transplants
Research

Keywords

  • advanced
  • Heart failure
  • stage D

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Fang, J. C., Ewald, G. A., Allen, L. A., Butler, J., Westlake Canary, C. A., Colvin-Adams, M., ... Givertz, M. M. (2015). Advanced (stage D) heart failure: A statement from the heart failure society of america guidelines committee. Journal of Cardiac Failure, 21(6), 519-534. https://doi.org/10.1016/j.cardfail.2015.04.013

Advanced (stage D) heart failure : A statement from the heart failure society of america guidelines committee. / Fang, James C.; Ewald, Gregory A.; Allen, Larry A.; Butler, Javed; Westlake Canary, Cheryl A.; Colvin-Adams, Monica; Dickinson, Michael G.; Levy, Phillip; Stough, Wendy Gattis; Sweitzer, Nancy K; Teerlink, John R.; Whellan, David J.; Albert, Nancy M.; Krishnamani, Rajan; Rich, Michael W.; Walsh, Mary N.; Bonnell, Mark R.; Carson, Peter E.; Chan, Michael C.; Dries, Daniel L.; Hernandez, Adrian F.; Hershberger, Ray E.; Katz, Stuart D.; Moore, Stephanie; Rodgers, Jo E.; Rogers, Joseph G.; Vest, Amanda R.; Givertz, Michael M.

In: Journal of Cardiac Failure, Vol. 21, No. 6, 01.06.2015, p. 519-534.

Research output: Contribution to journalArticle

Fang, JC, Ewald, GA, Allen, LA, Butler, J, Westlake Canary, CA, Colvin-Adams, M, Dickinson, MG, Levy, P, Stough, WG, Sweitzer, NK, Teerlink, JR, Whellan, DJ, Albert, NM, Krishnamani, R, Rich, MW, Walsh, MN, Bonnell, MR, Carson, PE, Chan, MC, Dries, DL, Hernandez, AF, Hershberger, RE, Katz, SD, Moore, S, Rodgers, JE, Rogers, JG, Vest, AR & Givertz, MM 2015, 'Advanced (stage D) heart failure: A statement from the heart failure society of america guidelines committee', Journal of Cardiac Failure, vol. 21, no. 6, pp. 519-534. https://doi.org/10.1016/j.cardfail.2015.04.013
Fang, James C. ; Ewald, Gregory A. ; Allen, Larry A. ; Butler, Javed ; Westlake Canary, Cheryl A. ; Colvin-Adams, Monica ; Dickinson, Michael G. ; Levy, Phillip ; Stough, Wendy Gattis ; Sweitzer, Nancy K ; Teerlink, John R. ; Whellan, David J. ; Albert, Nancy M. ; Krishnamani, Rajan ; Rich, Michael W. ; Walsh, Mary N. ; Bonnell, Mark R. ; Carson, Peter E. ; Chan, Michael C. ; Dries, Daniel L. ; Hernandez, Adrian F. ; Hershberger, Ray E. ; Katz, Stuart D. ; Moore, Stephanie ; Rodgers, Jo E. ; Rogers, Joseph G. ; Vest, Amanda R. ; Givertz, Michael M. / Advanced (stage D) heart failure : A statement from the heart failure society of america guidelines committee. In: Journal of Cardiac Failure. 2015 ; Vol. 21, No. 6. pp. 519-534.
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