Decision-making in Advanced Heart Failure

Clyde W. Yancy*

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter


This chapter provides a discussion on decision-making in issues surrounding advanced heart failure (HF). It concentrates on patients with American College of Cardiology/American Heart Association (ACC/AHA) Stage D HF. It introduces the natural history of advanced HF. It addresses the evidence that guides management of ACC/AHA Stage D HF. The uses of inotropes, device therapy with a defibrillator and/or cardiac resynchronization pacemaker, and left-ventricular assist device (LVAD) are presented. Next, it reports the importance of transplantation and handling difficult treatment discussions. Medicine is an art and the best practitioners are humble students of science, clinical practice, and life experiences. The real test of a physician is not how tall one stands at the time of triumph but how gracious one bows at the time of death.

Original languageEnglish (US)
Title of host publicationSupportive Care in Heart Failure
PublisherOxford University Press
ISBN (Electronic)9780191730030
ISBN (Print)9780198570288
StatePublished - Nov 17 2011


  • Advanced heart failure
  • American college of cardiology
  • American heart association
  • Cardiac resynchronization pacemaker
  • Decision-making
  • Defibrillator
  • Device therapy
  • Inotropes
  • Transplantation

ASJC Scopus subject areas

  • General Nursing


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