Synopsis
Recognise advanced-heart-failure referral triggers, match temporary or durable support to a bridge goal and understand the UK specialist pathway to transplantation.
- Refer advanced HF early: recurrent admission, escalating diuretic, prior inotrope, NYHA III–IV despite therapy, low BP, worsening renal/liver function, severe RV dysfunction or ventricular arrhythmia are red flags.
- Every device needs a bridge goal: recovery, intervention, decision, candidacy, transplantation or long-term support; reassess that goal daily in temporary MCS.
- An intra-aortic balloon pump modestly augments coronary perfusion; a microaxial LV pump unloads the LV; VA-ECMO supplies circulation plus gas exchange but may increase LV afterload; an RVAD supports isolated RV failure.
Key red flags
Rising lactate, escalating vasoactive support and multi-organ injury despite cause treatment may require temporary MCS before irreversibility.
Investigation priorities
Confirm severity, RV function, reversibility and referral urgency.
Management branches
One or more advanced-HF red flags despite guideline-directed therapy
- Refer to an advanced-HF/transplant centre while optimising four-class therapy, rhythm, CRT/ICD, valve/coronary disease, congestion, iron and rehabilitation.
- Send the trajectory: admissions, inotrope/diuretic exposure, BP, renal/liver function, RV/LV imaging, arrhythmia and functional status.