Table 6.2. Criteria proposed by various cardiology societies to identify advanced HF patients.

Criterion	SBC	ACC/AHA	ESC	HFSA
Severe and persistent symptoms despite optimized therapy	✓	✓	✓	✓
Major functional limitation (NYHA III or IV functional class)	✓	✓	✓	✓
Persistent dyspnea in daily living activities		✓
Recurring hospitalizations	✓	✓	✓	✓
Frequent unplanned visits to the emergency department	✓		✓	✓
Intolerance to maximum optimal medical therapy	✓	✓		✓
End-organ dysfunction	✓	✓		✓
Persistent hyponatremia	✓	✓		✓
Pulmonary or systemic congestion refractory to diuretics	✓	✓		✓
Frequent ICD shocks	✓	✓		✓
Cardiac cachexia	✓	✓		✓
Systolic blood pressure frequently ≤ 90 mm Hg		✓
Persistently elevated BNP or NT-proBNP values	✓		✓
Severe dysfunction with reduced LV ejection fraction (LVEF < 30%)	✓		✓	✓
Severe LV dysfunction with pseudonormal or restrictive pattern	✓		✓
Elevated filling pressures (PCWP > 16 mm Hg +/- CVP > 12 mm Hg)			✓
Low capacity in 6MWT (< 300 m) or VO2 peak < 12-14 mL.kg-1.min-1	✓		✓	✓
Dependence on intravenous inotropes	✓			✓
Progressive RV dysfunction and secondary PH	✓			✓

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; ACC/AHA: American College of Cardiology/American Heart Association; BNP: B-type natriuretic peptide; CVP: central venous pressure; ESC: European Society of Cardiology; HF: heart failure; ICD: implantable cardiac defibrillator; HFSA: Heart Failure Society of America; LV: left ventricle; NT-proBNP: N-terminal portion of B-type natriuretic peptide; NYHA: New York Heart Association; PCWP: pulmonary capillary wedge pressure; PH: pulmonary hypertension; RV: right ventricle; VO₂: oxygen consumption.