When to Consider Advanced Heart Failure Care
Early recognition of advanced heart failure is essential for timely intervention. The "I NEED HELP" mnemonic provides clear clinical triggers indicating when specialized advanced heart failure therapies—such as heart transplantation or left ventricular assist devices (LVADs)—should be considered. Early referral can significantly improve outcomes and quality of life.
"I NEED HELP" Criteria:
I - Intravenous Inotropes
- Patients requiring IV medications to support heart function such as milrinone or dobutamine
N - NYHA Class III or IV or Elevated Natriuretic Peptides
- Significant symptoms at rest or minimal exertion (NYHA class III/IV), or persistently high BNP or NT-proBNP levels.
E - Ejection Fraction ≤35%
- Reduced heart pumping function indicating severe heart failure.
E - End-organ Dysfunction
- Signs of compromised kidney, liver, or other organ systems due to heart failure.
D - Defibrillator Shocks
- Receiving shocks from an implanted defibrillator, indicating life-threatening arrhythmias.
H - Hospitalizations (>1 in the past year)
- Multiple hospitalizations for heart failure exacerbations.
E - Edema despite Escalating Diuretics
- Persistent fluid retention even with increasing doses of diuretics.
L - Low Blood Pressure and High Heart Rate
- Consistently low blood pressure combined with an elevated heart rate, indicating poor cardiac output.
P - Prognostic Medications (Intolerance or Down-titration)
- Unable to tolerate or progressively reducing guideline-directed medical therapies (GDMT).
Next Steps for Referral
Providers: If your patient meets any of these criteria, please refer them to the Samsky Advanced Heart Failure Center by calling 404-605-1964.
Patients: If you recognize any of these signs in your condition, please discuss advanced heart failure care with your healthcare provider or directly contact us at 404-605-5140.
Proactive care can transform patient outcomes—don't delay in seeking advanced support.