Table 4.

‘I NEED HELP’ acronym

I	Inotropes	Previous or ongoing requirement for dobutamine, milrinone, dopamine or levosimandan
N	NYHA classification/Natriuretic peptides	Persisting NYHA class III or IV and/or persisting high BNP or NT-proBNP
E	End-organ dysfunction	Worsening renal or liver dysfunction in the setting of heart failure
E	Ejection fraction	Very low ejection fraction <20%
D	Defibrillation shocks	Recurrent appropriate defibrillator shocks
H	Hospitalisations	More than 1 hospitalisation for heart failure in the last 12 months
E	Edema/Escalating diuretics	Persisting fluid overload and/or increasing diuretic requirement
L	Low blood pressure	Consistently low BP with a systolic <90–100 mm Hg
P	Prognostic medication	Inability to up-titrate (or need to decrease or cease) ACEI, β‑blockers, ARNIs or MRAs

(Adapted from [20] with permission)

ACEI angiotensin-converting enzyme inhibitor, ARNI angiotensin-receptor neprilysin inhibitor, BNP B-type natriuretic peptide, BP blood pressure, MRA mineralocorticoid receptor antagonist, NT-proBNP N-terminal pro-b-type natriuretic peptide, NYHA New York Heart Association