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. 2021 Jun 8;116(6):1174–1212. [Article in Portuguese] doi: 10.36660/abc.20210367

Table 6.1. Criteria for the definition of advanced heart failure.

Criteria for advanced HF
1. Persistent and severe HF symptoms (NYHA III or IV).
2. Severe ventricular dysfunction defined by:

  • LVEF ≤ 30% or

  • Isolated right HF or

  • Severe inoperable valvular alterations or

  • Congenital abnormalities


Persistently elevated BNP or NT-proBNP levels and data showing severe diastolic dysfunction or structural LV abnormalities, according to the criteria for HFpEF or HFmrEF.
3. Episodes of systemic or pulmonary congestion requiring high doses of intravenous diuretics (or combinations of diuretics) or episodes of low cardiac output requiring the use of inotropes or vasoactive medications or malignant arrhythmias causing more than one unplanned visit to the emergency department or hospitalization in the last 12 months.
4. Severely reduced physical exercise capacity, with inability to perform or low capacity in the 6-minute walk test (6MWT < 300 m) or VO2 peak (< 12-14 mL.kg-1.min-1), of likely cardiac origin.

Adapted from Metra M et al.65Eur J Heart Fail. 2007; 9(6-7): 684-94; Metra M et al.66Cardiac Fail Rev. 2019; Crespo-Leiro MG et al.67Eur J Heart Fail. 2018; 20(11): 505-35; Trusby LK et al.,68JACC Heart Fail. 2020; 8(7): 523-36.

6MWT: 6-minute walk test; BNP: B-type natriuretic peptide; HF: heart failure; HFmrEF: heart failure with mid-range ejection fraction; HFpEF: heart failure with preserved ejection fraction; LV: left ventricle; LVEF: left ventricular ejection fraction; NYHA: New York Heart Association; NTproBNP: N-terminal portion of B-type natriuretic peptide; VO2: oxygen consumption.