Heart failure (HF) is a frequent and severe condition. It is estimated that one in four patients will die within a year following hospitalization for acute decompensation, with significant variations across age strata. A recent study reported that the 1-year mortality following hospitalization for HF was 9%, 14%, and 18% for patients under 55, between 55–64, and 65–74 years, respectively.¹ Higher values are found when older and unselected patients are included.²

Another rather recent worrisome finding is the increase in the incidence of HF among younger individuals due to a rise in ischaemic heart disease, especially among men aged 36–50 years in Europe.³ Although younger than 50 years, this population will experience a 25% readmission rate for HF, and 75% for all causes with a mortality exceeding 10% at 2 years.³ Consistent data show an increasing incidence of cardiogenic shock following myocardial infarction among the young, along with an associated increase in mortality from ischaemic cardiogenic shock within this same demographic.⁴ Moreover, epidemiological data confirm that mortality due to HF among young individuals is generally on the rise in North America, even as the availability of treatments and devices continues to increase.⁵ This subgroup of young patients who develop acute coronary syndrome followed by severe cardiac dysfunction and HF is an obvious target for treatment with long-term mechanical circulatory support (MCS) and heart transplantation.

The treatment for HF with reduced ejection fraction relies on four therapeutic classes including beta-blockers, renin–angiotensin system inhibitors, mineralocorticoid receptor antagonists (MRAs), and sodium–glucose cotransporter 2 inhibitors (SGLT2i), each with a class I recommendation.⁶ Meta-analyses of randomized clinical trials demonstrate that the implementation of these four classes could reduce all-cause mortality by 61%, with an estimated increase in survival of 5 years for a patient who would be 70 years old.⁷ However, tolerance of HF treatments is poor, with discontinuation rates ranging from 23% (SGLT2i) to 42% (MRAs) at 1 year according to a multinational observational study.⁸ This intolerance is a sign of advanced HF, and the more risk factors patients have, the higher the likelihood of treatment intolerance becomes.⁹ In these populations with advanced disease, significant myocardial fibrosis makes hormonal therapies ineffective and intolerable, necessitating invasive mechanical therapies based on Laplace’s law to reduce left ventricular intraluminal pressure.