Table 1. European Society of Cardiology criteria defining stage of advanced HF.

All following criteria should be present despite optimal medical therapy
1	Severe and persistent symptoms of heart failure
	NYHA class III or IV
2	Severe cardiac dysfunction defined by at least one of following
	LVEF ≤30%
	Isolated RV failure
	Non-operable severe valvular abnormalities
	Non-operable severe congenital abnormalities
	Severe HF with mildly reduced or preserved EF defined by persistently high BNP or NT-pro-BNP values and significant LV diastolic dysfunction
3	Repeated episodes of HF aggravation causing unplanned visits or hospitalization with one of following conditions in the last 12 months
	Congestion requiring intravenous diuretics or diuretic combination
	Low cardiac output requiring inotropes or vasoactive agents
	Malignant arrhythmia
4	Severe impairment of exercise capacity with inability to exercise or low 6-minute walk test distance (<300 m) or peak VO2 (<12–14 mL/kg/min) or <50% predicted value, estimated to be of cardiac origin

HF = heart failure; NYHA = New York Heart Association; LVEF = left ventricular ejection fraction; RV = right ventricular; EF = ejection fraction; BNP = brain natriuretic peptide; NT-pro-BNP = N-terminal pro-B-type natriuretic peptide; VO₂ = oxygen consumption.

Adapted from McDonagh et al.⁶⁾ with the permission of the European Society of Cardiology.