Table 1.

Recommendations for heart failure patients going to high altitude

HF severity level	Recommendations	Class of evidence	Level of evidence	References
All HF patients	Carefully evaluate HF co-morbidities (e.g. pulmonary hypertension, anaemia, sleep apnoea)	I	C
	Carefully evaluate HF drugs (in particular diuretics, potassium supplementation, and β blockers). Whenever possible, β1 selective should be preferred to non-selective beta-blockers	I	B	10,13,20S
	Slow ascent is recommended. Although we do not have precise data on advisable ascent rate, it is prudent not to exceed that recommended for healthy travellers (300–500 m/day when above 2500 m)	I	C
Stable NYHA I-II patients	May safely reach high altitude up to 3500 m	IIa	C	25
	Once at altitude, not heavier than moderate physical activity is recommended	IIa	C	25
Stable NYHA III patients	May safely reach high altitude up to 3000 m, if needed	IIa	C	24
	Once at altitude, not heavier than light physical activity is recommended	IIa	C	23,24
Unstable/NYHA IV patients	Avoid high altitude exposure	I	C

The strength of these recommendations is to be weighted in the light of the limited evidence available.

HF, heart failure; NYHA, New York Heart Association.