The authors of the article have analyzed the problem of advanced heart failure (AHF). Despite significant and, it is not an exaggeration to say, revolutionary achievements in clinical pharmacology, cardiac surgery and implantation arrhythmology, the number of patients with chronic heart failure (CHF) in many countries is not decreasing, and in some, for example, in Russia, it is increasing. At the same time, unfortunately, often the immediate and longterm results of the so-called optimal therapy of CHF are disappointing for both the patient and the doctor. In 2007, experts from The Heart Failure Association of the European Society of Cardiology proposed the term AHF to refer to CHF in which optimal drug therapy, as well as cardiac resynchronization therapy, are not effective, which causes repeated hospitalizations and justifies the need for the advanced treatment methods such as heart transplantation and mechanical circulatory support, and/or transition to palliative care. The agreed positions of experts from the established cardiological communities in the Old and New Worlds on the definition, diagnostic criteria and treatment of AHF have been changing over time. Unfortunately, this evolution has not yet arrived at a consensus. The lecture consistently addresses the issues of terminology, diagnosis, prognostic stratification and routing of patients with AHF, as well as short- A nd long-term strategies for treating these patients.