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Heart failure (HF) is a frequent cause of inpatient admissions. The Framingham study in 1993 described the risk factors for heart failure and showed unacceptably high five-year mortality rates of 25% in men and 38% in women . The American Heart Association reported the prevalence of HF to be 5.1 million in the United States in 2006 . The worldwide prevalence has been estimated to be 23 million . HF can be categorized based on the left ventricular ejection fraction (LVEF) into systolic and diastolic HF. The former group includes patients with LVEF less than or equal to 40%, also termed heart failure with reduced ejection fraction (HFrEF). Heart failure with preserved ejection fraction (HFpEF) includes those with LVEF greater than or equal to 40%.  The multiple modalities of treatment available to treat HF include but are not limited to lifestyle modifications, pharmacologic agents, device therapies such as implantable cardioverter-defibrillator (ICD), and cardiac resynchronization therapy (CRT). At times, failure to improve could necessitate short-term mechanical circulatory support with the use of an intra-aortic balloon pump (IABP) or even extracorporeal membrane oxygenation (ECMO). However, a large population of patients continues to have advanced heart failure with worsening LVEF despite maximal therapy. Circulatory support with the use of a left ventricular assist device (LVAD) is an emerging field. The landmark REMATCH trial that compared LVADs with optimal medical therapy in class IV HF patients found a 48% reduction in mortality from any cause . There was also a significant increase in the survival rates at one year (52% versus 25%) and two years (23% versus 8%). The definitive treatment for advanced HF (class II and IV) is cardiac transplantation . However, with the limited number of donor hearts available, LVADs are life-saving.

PMID: 29763016