We recommend that the decision to refer patients with HF and ischemic heart disease for coronary revascularization should be made on an individual basis and in consideration of all cardiac and noncardiac factors that affect procedural candidacy.
(Strong Recommendation, Low-Quality Evidence)

We recommend that efforts be made to optimize medical status before coronary revascularization, including optimizing intravascular volume medical therapy.
(Strong Recommendation, Low-Quality Evidence)

We recommend that performance of coronary revascularization procedures in patients with chronic HF and reduced LVEF be undertaken with a medicalsurgical team approach with experience and expertise in high-risk interventions.
(Strong Recommendation, Low-Quality Evidence)

Values and preferences: This recommendation reflects the preference that high-risk revascularization is best preformed in higher volume centres with significant experience, and known, published outcomes.

Practical tip: Assessment for advanced HF therapies, by an appropriate team, should be performed before the revascularization procedure in any patient with advanced HF.