Table 1: Triggers for Referral for Advanced Therapy.

Clinical	Laboratory	Imaging	Risk Score Data
>1 HF hospitalisation in past year NYHA class III—IV Intolerant of optimal dose of any GDMT HF drug Increasing diuretic requirement SBP ≤90 mmHg Inability to perform CPET 6MWT CRT non-responder clinically Cachexia, unintentional weight loss KCCQ MLHFQ	eGFR <45 ml/min SCr ≥160 mmol/ K >5.2 or <3.5 mmol/ Hyponatraemia Hb ≤120 g/l NT-proBNP ≥1000 pg/ml Abnormal liver function test Low albumin	LVEF ≤30% Large area of akinesis/dyskinesis or aneurysm Moderate—severe mitral regurgitation RV dysfunction PA pressure ≥50 mmHg Moderate-severe tricuspid regurgitation Difficult to grade aortic stenosis IVC dilated or without respiratory variation	MAGGIC predicted survival ≤80% at 1 year SHFM predicted survival ≤80% at 1 year

6MWT = 6-min walk test; CPET = cardiopulmonary exercise test; CRT = cardiac resynchronization therapy; eGFR = estimated glomerular filtration rate; GDMT = guideline-directed medical therapy; Hb = haemoglobin; HF = heart failure; IVC = inferior vena cava; K = potassium; KCCQ = Kansas City Cardiomyopathy Questionnaire; LVEF = left ventricular ejection fraction; MAGGIC = Meta-Analysis Global Group in Chronic Heart Failure; MLHFQ = Minnesota Living with Heart Failure Questionnaire; Na = sodium; NT-proBNP = N-terminal pro-B-type natriuretic peptide; NYHA = New York Heart Association; PA = pulmonary artery; RV = right ventricular; SBP = systolic blood pressure; SCr = serum creatinine; SHFM = Seattle Heart Failure Model. Source: Crespo-Leiro et al. 2018.19 Reproduced with permission from John Wiley and Sons.