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European Heart Journal Advance Access originally published online on January 31, 2006
European Heart Journal 2006 27(7):770-772; doi:10.1093/eurheartj/ehi759
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Who needs a heart transplant?

Roy S. Gardner1, Theresa A. McDonagh2, Michael MacDonald1, Henry J. Dargie1, Andrew J. Murday1 and Mark C. Petrie1,*

1Department of Cardiology, Glasgow Royal Infirmary, Alexandra Parade, Glasgow, UK
2Royal Brompton Hospital, London, UK

Received 28 October 2005; revised 8 January 2006; accepted 12 January 2006; online publish-ahead-of-print 31 January 2006.

* Corresponding author. Tel: +44 0141 211 4833. E-mail address: mcp1n@udcf.gla.ac.uk

The first 150 words of the full text of this article appear below.

Who needs a heart transplant?

The aim of transplant assessment programmes is selecting a patient who will benefit from receiving a cardiac transplant. The recipient should be expected to live longer with a better quality of life when compared with continuing on medical (or other non-transplant) therapy. Until the mid-1990s, the management of heart failure comprised angiotensin-converting enzyme inhibitors (ACE), diuretics, and digoxin. With this limited armoury, there was consensus that many ambulant patients with NYHA classes III and IV chronic heart failure would benefit from heart transplantation. Since the late 1990s, there has been a dramatic change in the management of heart failure. Beta-adrenoreceptor, aldosterone and angiotensin receptor blockers, implantable cardioverter defibrillators, and cardiac resynchronization therapy have all become established therapies that reduce mortality rates.1–5 With this improvement in therapy for heart failure, we have to reassess who would benefit from heart transplantation.

How do we select patients?

Quantifying the risk of an individual with heart failure . . . [Full Text of this Article]

Heart Failure Survival Score

Is the HFSS relevant to patients with advanced heart failure in 2005?
Derivation and validation of the HFSS
What did the HFSS predict?
Other concerns related to the HFSS in 2006?
What might predict prognosis better than the HFSS?
BNP: alone or as part of a revalidated HFSS
Pulse pressure
Who does need a heart transplant?

Hospitalized patients
Patients with decompensated heart failure
Patients with cardiogenic shock complicating myocardial infarction
Outpatients
Risk of morbidity and mortality post-cardiac transplantation

Assessment standards/medical optimization

Conclusions


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