Hello! Thank you for asking on HCM! I would like to conferm your concern about the importance of dealing with a patient that suffers from heart failure. As heart failure is the final step during the course of most complicated cardiac diseases, it appears as one of the most life-threatening condition when left untreated properly. Judging form her severely compromised cardiac performance (very low EF around 20%), the risk from life remains very high even on the hospital settings. Life-threatening cardiac arrhythmia and refractory acute heart failure appears potential major risks when dealing with these patient. The prognosis remain poor even with the most appropriate medical therapies. Cardiac Resyncronisation Therapy (CRT) when feasible, and possible circulatory assist devices remain useful options when available. It is very important educating patients with heart failure and their relatives about medication compliance and to realise detection of new symtoms. In yuor case the most important issue is to manage inhospital complications and to discharge alive the patient in a more favorable condition. I think that doctors will discuss these issues with the close relatives, as it is crucial for the patient management. Hope to have been helpful to you. Greetings! Dr. Iliri