Heart failure is a very common disease and it affects 5.8 millions of the American population and over 23 million worldwide and the number is rising (1). There are multiple causes of the heart failure: ischemic heart disease and non ischemic heart failure (due to Alcohol, HIV, post partum…). There are two types of the heart failure: heart failure with reduced EF ( HfrEF) and heart failure with preserved EF ( HfpEF). The Median prevalence of systolic heart failure was 5.5 and diastolic heart failure was 36% and all type of heart filature had a median prevalence rate of 11.8 % with HfpEF more common than the HfrEF (median prevalence 4.9% vs. 3.3%. (2). There are 5 classes of the heart failure according to the NYHA classification (functional
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Stage C structural heart disease with symptoms. Stage D: refractory hf and need interventions. Stage D heart failure is a refractory type of heart failure to optimal medical treatment with ACEI,beta blockers, diuretics and angiotensin antagonist. There are half of millions of end stage heart failure with reduced EF ( HfrEF) and the average survival is less than 6 months (5) The treatment options for stage D acute decompensate heart failure include: inotropes, mechanical circulatory support (including: IABP, LVD (intermediate and long term, Cardiopulmonary assist devices), heart transplantation (3). Inotropes can be used for multiple purposes in heart failure: as a bridge to the heart transplantation for patients who meet criteria for the transplantations (depending on the heart transplant center). Inotropes can also be used as a bridge to the mechanical circulatory support (LVAD, impella, IABP). For patients who are not candidate for the heart transplantation or mechanical support or those who refuse the invasive treatment (the transplantation or the mechanical support devices), inotropes can be used as a palliative treatment (3). In some patients, inotropes can be weaned
Stage C structural heart disease with symptoms. Stage D: refractory hf and need interventions. Stage D heart failure is a refractory type of heart failure to optimal medical treatment with ACEI,beta blockers, diuretics and angiotensin antagonist. There are half of millions of end stage heart failure with reduced EF ( HfrEF) and the average survival is less than 6 months (5) The treatment options for stage D acute decompensate heart failure include: inotropes, mechanical circulatory support (including: IABP, LVD (intermediate and long term, Cardiopulmonary assist devices), heart transplantation (3). Inotropes can be used for multiple purposes in heart failure: as a bridge to the heart transplantation for patients who meet criteria for the transplantations (depending on the heart transplant center). Inotropes can also be used as a bridge to the mechanical circulatory support (LVAD, impella, IABP). For patients who are not candidate for the heart transplantation or mechanical support or those who refuse the invasive treatment (the transplantation or the mechanical support devices), inotropes can be used as a palliative treatment (3). In some patients, inotropes can be weaned