{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T17:35:28Z","timestamp":1793208928821,"version":"4.5.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":112,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Swedish Heart and Lung Foundation","doi-asserted-by":"publisher","award":["20220680"],"award-info":[{"award-number":["20220680"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Advanced heart failure (AdvHF) remains a major clinical challenge, yet contemporary epidemiological real-world data on AdvHF patients are limited. The aim was to assess 20-year trends in clinical characteristics, outcomes, and use of left ventricular assist devices (LVAD) and heart transplantation (HTx) in patients with AdvHF and reduced ejection fraction (AdvHFrEF) in Sweden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Between 2003 and 2022, 5323 patients (median age 76 [IQR 68\u201382], 23% females) included in the Swedish HF Registry met adapted ESC-HFA criteria for AdvHF (NYHA III\u2013IV, EF &amp;lt;30%, \u22651 HF hospitalization \u22646 months). Of these, 29% were eligible for AdvHF therapies (median age 63 [IQR 57\u201367] years, 18% females) according to the following additional criteria: \u226470 years old, no dialysis within \u22645 years, no active cancer within \u22643 years.<\/jats:p>\n                    <jats:p>Unadjusted temporal trends in 1-year outcomes (all-cause, CV and non-CV death, HTx, and LVAD implantation) were presented as estimated annual percent change (eAPC). 1-year all-cause mortality declined significantly in the overall cohort (eAPC \u22123.8; 95%CI \u22125.3 to \u22122.2) as well as in patients eligible for AdvHF therapies (eAPC \u22123.2; 95%CI \u22126.3 to \u22120.1) over the study period. These improvements were largely driven by reductions in CV mortality (overall cohort: eAPC \u22124.3; 95%CI \u22126.0 to \u22122.6; eligible cohort: eAPC \u22125.6, 95%CI \u22129.4 to \u22121.7). Use of LVAD significantly increased over the study period, while HTx showed a modest but non-significant rise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In a large nationwide cohort, all-cause and CV-mortality among AdvHFrEF patients markedly declined over the past 20 years, potentially reflecting improvements in treatments. Despite progress, significant opportunities remain to improve access to and adoption of advanced therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejhf\/xuag241","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T11:36:00Z","timestamp":1784633760000},"page":"726-737","source":"Crossref","is-referenced-by-count":1,"title":["Trends in mortality, heart transplantation, and left ventricular assist device use in advanced heart failure between 2003 and 2022: data from the Swedish Heart Failure Registry"],"prefix":"10.1093","volume":"28","author":[{"given":"Federica","family":"Guidetti","sequence":"first","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Karolinska Institute , Sjukhusbacken 10, Stockholm 118 83 ,","place":["Sweden"]},{"name":"Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital , Bern 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