Thomas Colletti, DHSc, PA-C, DFAAPA
Advanced heart failure (AdHF) is the last stage of heart failure (HF) and is characterized by patients with HF who experience worsening symptoms despite optimized, goal-directed medical treatment (GDMT) and interventions. At this stage, patients with AdHF should be referred for AdHF therapies, including evaluation for left ventricular assist device (LVAD) or orthotopic heart transplantation (HT). Timing is vital in the selection process and can determine whether an individual is listed for heart transplant, undergoes LVAD implantation, or is referred for other forms of palliative care. LVAD is considered to be the best option for a patient, and there are three options: bridge to transplant, bridge to decision, or durable/destination therapy. The technological advancements in LVADs have made these more durable and reliable for individuals with AdHF. Although LVADs are still not widely used, they have become an increasingly prevalent alternative for symptomatic HF given the improved long-term outcomes. Following implantation individuals with AdHF live longer and can have active lifestyles, have fewer hospital admissions, and have (or experience) reduced morbidity and mortality rates compared to medical therapies alone. Educating practitioners on the early signs of worsening HF can aid appropriate and timely referral of patients. Further research is needed to assess how LVADs contribute to the long-term (5th and 10th year) reduction of costs associated with AdHF, reduction of morbidity and mortality rates, and improvement of functional status past 5 years in large cohorts.
Williams AT. Surgical Interventions for the Treatment of Advanced Heart Failure. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2023; 5(1).
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