Congestive heart failure treatment of patients with refractory end-stage heart failure (Stage D)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

ACC / AHA Guidelines- Treatment of Patients with Refractory End-Stage Heart Failure (Stage D) (DO NOT EDIT)

“

Class I 1. Meticulous identification and control of fluid retention is recommended in patients with refractory endstage HF. (Level of Evidence: B) 2. Referral for cardiac transplantation in potentially eligible patients is recommended for patients with refractory end-stage HF. (Level of Evidence: B) 3. Referral of patients with refractory end-stage HF to an HF program with expertise in the management of refractory HF is useful. (Level of Evidence: A) 4. Options for end-of-life care should be discussed with the patient and family when severe symptoms in patients with refractory end-stage HF persist despite application of all recommended therapies. (Level of Evidence: C) 5. Patients with refractory end-stage HF and implantable defibrillators should receive information about the option to inactivate defibrillation. (Level of Evidence: C) Class IIa 1. Consideration of an LV assist device as permanent or “destination” therapy is reasonable in highly selected patients with refractory end-stage HF and an estimated 1-year mortality over 50% with medical therapy. (Level of Evidence: B) Class IIb 1. Pulmonary artery catheter placement may be reasonable to guide therapy in patients with refractory end-stage HF and persistently severe symptoms. (Level of Evidence: C) 2. The effectiveness of mitral valve repair or replacement is not established for severe secondary mitral regurgitation in refractory end-stage HF. (Level of Evidence: C) 3. Continuous intravenous infusion of a positive inotropic agent may be considered for palliation of symptoms in patients with refractory end-stage HF. (Level of Evidence: C) Class III 1. Partial left ventriculectomy is not recommended in patients with non ischemic cardiomyopathy and refractory end-stage HF. (Level of Evidence: C) 2. Routine intermittent infusions of positive inotropic agents are not recommended for patients with refractory end-stage HF. (Level of Evidence: B)

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See Also

• The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Sources

• The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

References

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