[Management of advanced or refractory heart failure].

Advanced heart failure, also be defined as stage D heart failure, characterized by advanced structural heart disease and marked symptoms of heart failure at rest despite dietary modification, salt restriction and maximal medical therapy including ACE inhibitors, angiotensin II receptor blockers, digitalics, diuretics and beta blockers. These patients require frequent hospitalizations and specialized interventions such as heart transplantation, implantation of mechanical assistance devices, continuous intravenous inotropic therapy to palliate symptoms, or continued terminal care.