Beyond Stage C: Considerations in the Management of Patients With Heart Failure Progression and Gaps in Evidence

Despite treatment with contemporary medical therapies for chronic heart failure (HF), there has been an increase in the prevalence of patients progressing to more advanced disease. Patients progressing to and living at the interface of severe stage C and stage D HF are under-represented in clinical trials, and there is a lack of high-quality evidence to guide clinical deci-sion making. For patients with severe HF phenotypes, the medical therapies used for patients with less advanced stages of illness are often no longer tolerated or provide inadequate clini-cal stability. The limited data on these patients highlights the need to increase formal research characterizing this high-risk population. This review summarizes existing clinical trial data and incorporates our considerations for approaches to the medical management of patients advanced "beyond stage C" HF. (J Cardiac Fail 2023;29:818-831)