In the 2002 article: Medical Management of Advanced Heart Failure by Drs. Nohria, Lewis, and Stevenson, (JAMA. 2002;287(5):628-640) the authors outline their approach to the management of tough heart failure cases. Two of the main concepts outlined here are the “Two-Minute Assessment of Hemodynamic Profile” which is a way of thinking about the heart failure state a patient may be in, and, secondly, the “Stepped Therapy for Heart Failure” which can be a helpful approach to therapy. Please see the attached images and thanks again for another great AM report at the VA!!