Heart failure occurs when the heart cannot pump enough blood to meet the body’s needs. End-stage heart failure is the most severe form of heart failure.
This article describes end-stage heart failure, including common signs and symptoms. We will also discuss the causes of this condition and how to manage, treat, and prevent it. We also explore the future outlook for patients with end-stage heart failure.
In people with heart failure, the heart weakens over time. Although management and treatment options can help people live with the symptoms caused by heart failure, heart failure is chronic and there is no cure.
In end-stage heart failure, the body is no longer able to compensate for the lack of blood pumped by the heart, limiting the ability of the heart to recover. You may have difficulty breathing even when you are resting.
Stage or class of heart failure
The final stage of heart failure is also called the terminal stage of heart failure.Doctors classify heart failure into stages
by
People with class IV heart failure
- Not being able to do much physical activity without feeling discomfort
- Symptoms of heart failure even at rest
- Experiencing increased discomfort regardless of the amount of physical activity
A person with stage D heart failure means:
- There is objective (observational) evidence of severe heart disease
- There are significant functional limitations
- Significant symptoms occur even when resting
other
Learn about the stages of congestive heart failure.
People with end-stage heart failure may experience symptoms of cardiovascular disease.
Symptoms may occur
End-stage heart failure can also cause kidney and liver dysfunction.
You may require periodic hospitalization, depend on daily IV medication, and your symptoms may not respond well to treatment. As heart failure progresses, it can get worse.
Learn about the symptoms of congestive heart failure.
Heart failure can become chronic and develop over time due to a medical condition that causes the heart to work harder than normal or damage it.
It can also be acute, caused by conditions that cause sudden damage to the heart, such as a heart attack or infection.
Over time, heart failure may progress to the point where drugs no longer work. A ventricular assist device or heart transplant is an option for some people, but others are not eligible because of chronic disease or certain medical conditions.
Heart failure tends to affect either the right or left side of the heart. However, in both cases, heart failure prevents the heart from pumping blood properly.
Many conditions can cause or contribute to heart failure.
Learn more about drug-induced cardiomyopathy.
There is no cure for end-stage heart failure. At this stage, people need to decide how much treatment they want without sacrificing their quality of life.
If you are in the final stages of heart failure, you may want to seek palliative or hospice care. This option helps provide great comfort in the last weeks and days of a person.
medicine
Drug therapy may help manage symptoms in patients with advanced heart failure.medicine
- Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: They reduce the level or action of angiotensin, a hormone that increases blood pressure.
- Beta blocker: This drug reduces heart rate and “cardiac workload.”
- Mineralocorticoid receptor antagonists: This drug reduces the harmful effects of aldosterone, a hormone that affects blood pressure by controlling salt and water levels.
- Sacubitril/Valsartan: This drug blocks the effects of the renin-angiotensin system, which controls blood pressure and blood water levels.
- SGLT2 inhibitors: these are helpful
reduce Risk of death or hospitalization in patients with heart failure. - Diuretics: These drugs increase urine production and remove fluid from the body.
- Hydralazine/isosorbide nitrate: This helps relax blood vessels and lower blood pressure.
- Digoxin: This drug increases the contraction of the heart muscle.
- inotropic agent: These include milrinone and dobutamine, which are given continuously through an IV drip to manage symptoms of advanced heart failure.
In some cases, patients with advanced heart failure may not be able to tolerate these drugs because of side effects such as decreased blood pressure. Intolerance is usually a marker of advanced disease.
Learn more about heart failure medications.
surgery
Some people may also have surgery to treat:
- Ventricular assist device: This mechanical support device helps the heart pump blood. Some people may need a left ventricular assist device, a right ventricular assist device, or a biventricular assist device.
- Biventricular pacemaker: Pacemakers allow the heart to pump more synchronously, allowing for more efficient blood delivery.
- Implantable defibrillator: This device assesses your heart rate and sends electrical pulses to correct abnormal heart rhythms.
You may also receive an artificial heart or heart transplant.
Some people get a peripherally inserted central catheter (PICC) line and receive IV medications at home to decongest the heart and support the heart’s pumping action while waiting for a transplant. There may be cases.
Learn more about treatments for end-stage heart failure.
palliative care
Palliative care aims to improve the quality of life of people with life-threatening conditions who usually have less than six months to live.
This may include treatment to reduce symptoms and address the psychosocial, mental, emotional, or spiritual needs of patients, their caregivers, and their loved ones. You may need treatment to extend your life.
Learn more about palliative care.
hospice care
Hospice care is not intended to extend a person’s life. We aim to manage symptoms and alleviate physical and emotional suffering so that patients with end-stage heart failure can live as dignified and comfortable lives as possible at home or in a hospice facility.
Click here to learn more about end-of-life planning.
There is no cure for end-stage heart failure. The exact outlook varies from person to person.
Patients with stage D heart failure typically have a decreased quality of life, according to a 2018 review.
People can use medications and other treatments and strategies to reduce the discomfort that end-stage heart failure can cause.
Life expectancy of patients with end-stage heart failure
The life expectancy of a patient with end-stage heart failure depends on the severity of symptoms and response to treatment.
When heart failure progresses to stage D, people experience a decreased quality of life and a high symptom burden, with a median life expectancy of only 6 to 12 months.
according to
- 86.5% of heart failure patients survive 1 year
- 72.6% of heart failure patients survive 2 years
- 56.7% of heart failure patients survive 5 years
- 34.9% of heart failure patients survive 10 years.
The overall 5-year survival rate for heart failure patients is approximately 60%.
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according to
Learn more about heart transplants.
The best way to prevent heart failure is to make lifestyle changes and establish habits that reduce your risk of developing diseases that cause or contribute to heart failure.
american heart association
Learn more about how to improve your heart health.
Caring for a loved one with end-stage heart failure can be challenging but rewarding. A caregiver may be needed to provide practical and emotional support. For example, practical support might include helping the person with laundry and dressing.
When caring for someone at the end of life, caregivers may find it helpful to:
- Ask your doctor what to expect if the disease progresses
- Ask your doctor about how to manage your symptoms
- Keep contact details for your doctor and medical team in a place that is easy to access or find
- Keep track of an after-hours number that you can contact on nights and weekends.
- Find out what support is available, including financial aid and support groups
Caregivers can also discuss hospice care with their loved one and the medical team.
Learn more about caregivers and home care.
Signs that a person with heart failure is nearing the end of life
Physical signs that a person is nearing the end of their life include:
- Shortness of breath at rest or with minimal exertion
- pain
- persistent cough
- fatigue or extreme fatigue
- limited physical activity
- fluid retention
- Cognitive impairments (such as problems with memory, language, and speech, and even sudden confusion)
- nausea and loss of appetite
People with end-stage heart failure may experience a wide range of emotions and feelings. They may experience things like:
- sorrow
- anger
- anxiety
- depression
- Feeling helpless or as if you have no control over your life
- unable to deal with other people’s reactions
People experiencing depression or anxiety may want to seek treatment from a mental health professional. Treatment may include cognitive behavioral therapy (CBT).
Learn about 14 types of treatments for mental and emotional problems.
End-stage heart disease is the most serious form of heart disease. People with this condition require medical intervention to stay alive, often involving a combination of drugs, procedures, and medical devices.
Symptoms of end-stage heart disease always or most of the time include difficulty breathing, feeling tired, weight loss, changes in skin color, swelling, and abdominal pain. These can get progressively worse.
Caring for patients with end-stage heart failure may require providing physical and emotional support. Talk to your family about seeking hospice care.
