**2.1 The identification and classification of advanced stage heart failure**

Advanced stage heart disease is a process that significantly reduces quality of life and survival, in which more serious signs and heart failure symptoms continue during mild effort and/or at rest despite optimal evidence-based medical treatment, device treatment, or surgical intervention and which requires several important decisions to be taken in management of the disease such as frequent re-admission to hospital, the need for inotropic treatment, and the placement of mechanical support devices or heart transplantation [6].

Since heart failure is a progressive syndrome, the necessity of evaluating the functional capacity and symptoms of the patients is also at the forefront. When the classification systems used to define the severity of HF are examined, it is seen that the American College of Cardiology [ACC] also includes the risk factors in the classification, and the New York Heart Association [NYHA] is a classification system based on functional status [7].

#### **Figure 1.**

*Advanced stage heart disease classification [7].*
