Table 6.3. Warning signs in advanced HF patients.

I	IV inotrope dependence
N	Persistent NYHA III/IV, persistent elevation in natriuretic peptides
E	End-organ dysfunction
E	Ejection (fraction) below 20%
D	Defibrillator shocks (recurring appropriate shock)
H	Recurring hospitalizations and emergency department visits in the last 12 months
E	Persistent edema, refractory to escalating diuretics
L	Low systolic blood pressure, persistently below 90 mm Hg
P	Progressive intolerance to optimized medical therapy