Support Therapy for Advanced Heart Failure

Abstract

Heart failure with altered systolic function is a common disease with high mortality despite the improvements in medical management during the last decades. Beyond the diagnosis period of the disease, it is common to observe a clinical stability for years. As heart failure worsens, patients will suffer from an important functional limitation, systemic disorders (i.e., renal failure, malnutrition), especially in case of uncontrolled congestion. This is advanced heart failure, which is generally poorly recognized in clinical practice. However, it is a crucial turning point in patient’s medical history, as long-term management of these patients must be anticipated as soon as possible in order to judge their eligibility for cardiac transplantation or mechanical circulatory support. Indeed, psychosocial patient status, the comorbidity burden, and multiorgan failure due to heart failure will condition the results of these treatments. Acute heart failure with cardiogenic shock and multiorgan failure can lead to intensive care unit admission and invasive management of cardiac failure with mechanical support and/or emergency cardiac transplantation. In this review, we will define advanced heart failure syndrome. We discuss indications for admissions in intensive care unit for patients with cardiogenic shock, and supportive care that can be proposed for multiorgan failure. We will also discuss strategies and conditions required for long-term therapies such as cardiac transplantation and ventricular assist device implantation.