Advanced HF

The ESC 2026 definition of advanced HF, the referral screen (Rule of three and I NEED HELP), the INTERMACS profiles and the treatment pathway.

The same values as in the patient editor in the header and on the other pages: change one here and it changes there.

Age(years)

Sex

LVEF(%)

Systolic BP(mmHg)

Heart rate(bpm)

Current creatinine(mg/dL)

Baseline creatinine(mg/dL)

eGFR override(mL/min)

Calculated 84 (CKD-EPI 2021)

NYHA class

On maintenance dialysis

Kidney stage: G2 (eGFR 60–89).

All four must be present despite foundational, additional and interventional therapy.

Severe and persistent symptoms (NYHA class III or IV)
Severe cardiac dysfunction: LVEF ≤30%, isolated RV failure, non-operable severe valve or congenital abnormality, or persistently high BNP/NT-proBNP with severe LV diastolic dysfunction or structural abnormality
≥2 unplanned visits or hospitalizations in 12 months for congestion needing high-dose i.v. diuretics (or combinations) or malignant arrhythmias, or ≥1 low-output episode needing inotropes or vasoactive drugs
Severe impairment of exercise capacity: unable to exercise, 6-min walk <300 m, pVO2 <12–14 mL/kg/min or <50% predicted, of cardiac origin

Not (yet) meeting the definition

0 of 4 criteria present; the ESC definition requires all four (missing: symptoms, dysfunction, episodes, exercise). A patient can still be at high risk of advanced HF (see the referral screen).

Advanced HF

Patient values the screen can use

Is it advanced HF? The ESC definition

Should this patient be referred? Rule of three and I NEED HELP

Rule of three (at least one)

I NEED HELP (at least one)

INTERMACS profile and pathway