How would you lead a goals of care discussion in terms of prognosis/survival likelihood for patients with inotropic dependent HFrEF with CRT-D on maximally tolerated GDMT? 

I usually start by reviewing the prognosis with inotrope-dependent HF, quote data from DT VAD trials (REMATCH). I assess the eligibility for DT VAD and transplantation and review the shared decision-making pathways (IDECIDE LVAD) if the patient is eligible for DT VAD.

If the patient is not a candidate for advanced heart failure therapies (transplant or VAD), I then initiate the conversation with the expected prognosis with inotrope therapies. I usually try to understand what is important for the patient, QOL goals, important milestones they want to witness, values, faith, and how they want to be treated towards the end of life. I then rely heavily on my palliative care colleagues to help expand on these themes and involve family in the disc...

In addressing the nuanced management and prognosis for patients with inotrope-dependent heart failure with reduced ejection fraction (HFrEF), recent scholarly discussions and research findings offer a comprehensive view that aligns with and expands upon the insights shared by esteemed experts Drs. @Dr. First Last, @Dr. First Last, and @Dr. First Last. This discourse encompasses the evolving landscape of heart failure management, from the utilization of advanced heart failure therapies, such as LVADs and cardiac resynchronization therapy (CRT), to the critical role of palliative care in enhancing quality of life and potentially extending survival.

Systematic Review on CRT in Inotrope-dependent HF

A recent systematic review and meta-analysis ad...