Abstract
Heart failure is a growing epidemic worldwide that confers a substantial medical and economic burden on our society. With the aging population and the improved treatment strategies made available over the last several decades including neurohormonal blockade, cardiac resynchronization, and multidisciplinary psychosocial interventions, the prevalence of advanced heart failure is increasing as patients with heart failure are living longer with parallel progression of their disease state. Judicious risk stratification and cautious patient selection are paramount in guiding appropriate therapies. It is imperative to understand the underlying pathophysiology, decision-making strategies, pharmacologic therapies, and comprehensive options in managing advanced heart failure. For patients who exhaust the widely available medical and surgical therapies, then additional algorithms and multidisciplinary decision teams must be in place for consideration of cardiac transplant or mechanical circulatory support device in this subcohort of advanced, end-stage heart failure.