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Introduction Deciding who should and who should not proceed with mechanical circulatory support (MCS)—including timing and device type—is one of the most difficult challenges in medicine. While there are now over 6 million people in the United States with heart…

Definition of Stage D Heart Failure The American College of Cardiology (ACC) and American Heart Association (AHA) guideline for the management of heart failure (HF) classifies disease progression into four stages. Stage A includes patients with risk factors for HF…

AcknowledgmentS The author gratefully acknowledges Drs. Mariell Jessup, Pavan Alturi, and Michael A. Acker, whose chapter on this topic in the prior edition of Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine served as the partial basis for the current…