Table 1.

Criteria and symptoms defining advanced heart failure.

Criteria	Description	Symptoms	Clinical Relevance
Ejection Fraction (EF)	Reduced EF (≤40%) indicative of heart pump failure	Severe fatigue	Poor prognosis; reflects systolic dysfunction
		Shortness of breath (dyspnea)	Impacts quality of life and exercise capacity
		Orthopnea	Indicates worsening congestion
		Paroxysmal nocturnal dyspnea	Suggests fluid overload during sleep
		Swelling (edema)	Reflects systemic venous congestion
NYHA Functional Classification	Class III: Marked limitation of activity	Decreased exercise tolerance	Guides treatment decisions and prognosis
	Class IV: Symptoms at rest	Cough or wheezing	May indicate pulmonary congestion
Biomarkers	Elevated B-type natriuretic peptide (BNP)	Rapid or irregular heartbeat	Higher levels correlate with severity
	Indicates heart stress and fluid overload	Confusion or difficulty concentrating	Suggests reduced cardiac output
Clinical Signs	Jugular venous distension (JVD)	Cold extremities	Indicates poor peripheral perfusion
	Peripheral edema	Cyanosis	Suggests severe heart failure
	Ascites (fluid in the abdomen)	Signs of worsening renal function	Renal impairment often accompanies advanced HF
Hospitalization History	Frequent hospitalizations for HF within the past year	Increased need for diuretics	Reflects worsening disease trajectory
	Indicates instability and high resource utilization		High risk of acute decompensation