Table 3.

Patient selection for referral to advanced heart failure centre using I NEED HELP

I	Inotropics	Previous or current need for inotropics
N	NYHA III–IV/Natriuretic peptides	Persisting NYHA III–IV or increased (NT-pro)BNP
E	End-organ failure	Deteriorating kidney and/or liver function
E	Ejection fraction	Severely depressed left ventricular function (ejection fraction <20%)
D	Defibrillator shocks	Repeated ICD shocks
H	Hospitalisations	More than 1 admission for heart failure in the last 12 months
E	Edema or escalating diuretics	Persisting congestion or increasing diuretic dose
L	Low blood pressure	Consistent low systolic blood pressure (<90–100 mm Hg)
P	Prognostic medication	Inability to titrate evidence based medication (ACE inhibitor/ARB/beta blocker/MRA or ARNI)

NYHA New York Heart Association, (NT-pro)BNP (N-terminal-pro) B‑type natriuretic peptide, ICD implantable cardioverter defibrillator, ACE angiotensin-converting enzyme, ARB angiotensin receptor blocker, MRA mineralocorticoid receptor antagonist, ARNI angiotensin receptor neprilysin inhibitor