Table 1.

Indications and contraindications for referral and consideration of advanced heart failure therapies (heart transplantation, ventricular assist device implantation).

Indications

Contraindications

NYHA Class III-IV despite optimal medical and device therapy 6-minute walk < 300 m (984 feet) and/or peak oxygen consumption < 12-14 cc/kg/min Intolerance or withdrawal of evidence-based HF medications (e.g., beta-blockers, ACE-inhibitors) due to hypotension Diuretic-refractory volume overload Worsening renal function Frequent acute HF hospitalizations not related to noncompliance Need for intravenous inotrope Refractory life-threatening ventricular arrhythmias or frequent ICD discharges Refractory debilitating angina despite revascularization and symptom-oriented therapies Heart Failure Survival Score (“high risk”) [7] Seattle Heart Failure Model (“high” score: 2-3) [12]

Noncompliance with medical regimen Active substance abuse Severe symptomatic cerebrovascular disease Severe dysfunction of other organs (lung, kidney1, liver1, coagulopathy) Active infection Active mental illness Inadequate social support Fixed, severe pulmonary hypertension 1,2 Morbid obesity (BMI > 35 kg/m2) 2 Age > 70 years 2 Recent or uncured malignancy 2 HIV 2 Hepatitis C 2 Abdominal aortic aneurysm Inability to tolerate anticoagulation 3

¹Consider dual-organ transplant.

²Relative or absolute contraindication for heart transplantation, but not for ventricular assist device (specific eligibility criteria vary by transplant center).

³Contraindication for ventricular assist device support, but not for heart transplantation.

Abbreviations: ACE – angiotensin converting enzyme, BMI – body mass index, HF – heart failure, ICD – implantable cardioverter defibrillator, NYHA – New York Heart Association.