Decision-making in Advanced Heart Failure

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.