Indications for heart transplantation: focus on advanced heart failure

Heart failure is one of the most important medical and social problems. Despite recent successes in the treatment of this disease, which have been achieved with guideline-recommended medical treatment, some patients become insensitive to the interventions. Refractoriness to treatment recommended by the guidelines means that patients cannot hope for symptom relief or prolongation of life. These individuals develop the phase of advanced heart failure and have the worst survival rates compared to other stages of chronic heart failure. In the absence of contraindications, heart transplantation is indicated for this group of patients. In the recent years, organ transplantation has been legalized and the work of cadaver donation institutions has been organized in Ukraine. These changes helped to significantly increase the annual number of heart transplantations in the country. The aim of the work is to systematize current knowledge about end-stage heart failure, to provide methods to timely diagnose advanced heart failure and indications for referral for heart transplantation. At least every tenth patient with heart failure may deteriorate to the advanced stage. The article details clinical trajectories of patients with heart failure, and a particular emphasis has been given to refractory patients in accordance with present guidelines and recommendations. The main pathophysiological links and corresponding clinical manifestations of advanced heart failure have been outlined. The problems of life expectancy prognosing and possible predictors of refractoriness to the treatment recommended by the guidelines have been discussed. Current diagnostic criteria for advanced heart failure have been specified, including physical, laboratory and imaging methods of examination. The principles of differential diagnosis, especially between symptomatic and advanced heart failure, have been considered. Triggers for referring patients to a heart transplant center have been detailed. Current guidelines for heart transplantation related to advanced heart failure have been given. Conclusions. Advanced heart failure is the progression of heart failure due to refractoriness to treatment. Diagnostic criteria for advanced heart failure have been developed relatively recently. This diagnosis requires an utmost understanding of pathophysiology and skills to examine cardiac patients using modern tools. Due to the extremely unfavorable prognosis, diagnosis of advanced heart failure is an absolute indication for referral to a heart transplant center.