Management of refractory heart failure
- Wilson S Colucci, MD
Wilson S Colucci, MD
- Section Editor — Heart Failure
- Professor of Medicine
- Boston University School of Medicine
Although the majority of patients with heart failure (HF) due to systolic dysfunction respond to optimal medical therapy, some patients do not improve or experience rapid and repetitive recurrences of symptoms. These patients have symptoms at rest or on minimal exertion and often require repeated prolonged hospitalizations for intensive management.
Specialized strategies are generally considered for these patients, including intravenous positive inotropic therapy, cardiac resynchronization therapy, ultrafiltration, mechanical circulatory support, surgery, or cardiac transplantation.
An overview of therapies used to treat refractory HF is presented here. Treatment strategies for HF due to systolic dysfunction and diastolic dysfunction and the use of pacemakers and cardiac resynchronization therapy are discussed separately. (See "Overview of the therapy of heart failure with reduced ejection fraction" and "Treatment and prognosis of heart failure with preserved ejection fraction" and "Overview of cardiac pacing in heart failure" and "Cardiac resynchronization therapy in heart failure: Indications".)
General considerations — The following are two important steps in the care of patients with refractory heart failure (HF):
●Identification of refractory HF first requires confirmation of the accuracy of the diagnosis, including recognition of any contributing conditions and ensuring that all conventional medical strategies have been optimally employed. Recommendations for patients with other stages of HF are also appropriate for patients with end-stage (stage D) HF. (See "Overview of the therapy of heart failure with reduced ejection fraction".)
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