The Hidden Cost of Denied Access: Advanced Heart Failure in Latin America

Advanced heart failure (AHF) represents the terminal stage of the syndrome, characterized by refractoriness to currently available pharmacological and non-pharmacological strategies. It is a condition associated with high morbidity and mortality rates and a disproportionate consumption of healthcare resources, imposing a substantial burden on both healthcare systems and families. With population aging and the increased survival of individuals with chronic heart disease, the prevalence of AHF is projected to grow steadily, with escalating impact on direct costs (hospitalizations, advanced therapies, intensive support) and indirect costs (loss of productivity and social dependency).^,

In high-income countries, costly interventions such as heart transplantation and long-term mechanical circulatory support have become consolidated therapeutic pillars that can alter the natural history of the disease. Heart transplantation remains the gold standard of treatment, although its practical application is limited by donor shortages and a high proportion of clinically ineligible patients. Within this therapeutic gap, left ventricular assist devices (LVADs) have progressively emerged as increasingly effective alternatives, particularly as destination therapy. The introduction of continuous-flow technologies and, more recently, magnetically levitated pumps, such as the HeartMate 3, has redefined prognosis, providing survival beyond five years in specialized centers.

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