ABSTRACT
The term ‘refractory heart failure’ lacks straightforward definition even when the discussion is restricted to chronic systolic ventricular dysfunction. The phrase provides little insight regarding the etiology or temporal nature of the underlying myocardial disease, comorbid conditions or attempted therapeutic interventions. One may reason that a patient has refractory heart failure simply based upon moderate residual or recurrent symptoms after standard medical therapy has been implemented. However, even if residual symptoms were minimal or absent, the patient with persistent adverse physical signs or prognostic markers has a continuing and significantly increased risk for morbidity and mortality.1 One could make a strong argument that this profile also depicts a patient with refractory heart failure that warrants increased scrutiny and more intensive therapy.
