The complex syndrome of heart failure has many
different clinical presentations. Its variations arise
from the diverse causes, differing degrees of ventricular
dysfunction, and wide array of signs and symptoms
present in any given patient.1 Despite this variability,
specific subsets of patients with heart failure
with unique clinical attributes, treatment needs, and
prognoses are being described. Patients with
advanced heart failure represent one of the most
important of these subsets. New studies suggest their
response to optimal medical treatment can be dramatic,
whereas their adverse medical economic
impact when poorly treated is large.