434. Heart Failure: Advanced Therapies Evaluation with Dr. Michelle Kittleson

Advanced heart failure management requires a systematic evaluation to determine if a patient’s heart is sufficiently compromised and if their overall physiology can support advanced interventions. Clinicians utilize the "I Need Help" mnemonic—encompassing recurrent hospitalizations, intolerance to guideline-directed medical therapy, and worsening symptoms—to identify candidates for advanced therapies. Hemodynamic assessment, specifically identifying "wet and cold" profiles via right heart catheterization, guides the use of diuretics and inotropes to stabilize patients. Dr. Michelle Kittleson emphasizes that the transplant evaluation process must rigorously assess extracardiac health, ensuring that comorbid conditions do not preclude successful outcomes. When deciding between durable LVADs and heart transplantation, shared decision-making remains paramount, balancing the immediate need for hemodynamic support against the long-term goal of transplantation, particularly as waitlist dynamics and technological advancements continue to evolve.