Everything to know about end stage heart failure

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People with end stage heart failure or disease tend to experience symptoms all the time, even when resting.

A person with end stage heart failure may experience symptoms of cardiovascular disease, including:

• difficulty breathing
• fatigue (lack of energy)
• abdominal pain
• severe, unexplained weight loss
• irregular heartbeat
• fluid retention

End stage heart failure can also cause a person to experience kidney or liver dysfunction.

A person can also need regular hospitalization or be dependent on daily intravenous medications, and their condition may not respond well to treatment. This can worsen as the heart failure progresses.

Learn about the symptoms of congestive heart failure here.

Heart failure can be chronic and develop over time due to medical conditions that make the heart work harder than normal or damage it.

It may also be acute and develop with conditions that cause sudden damage to the heart, such as infection, blood clots in the lungs, valve problems, or a heart attack.

Over time, heart failure may progress to the point where medications, ventricular assist devices, and other treatment options, aside from a heart transplant, are no longer feasible.

When this occurs, it means the person is experiencing the end stage of heart failure.

Heart failure tends to impact either the right side of the heart or the left. But in both cases, heart failure causes the heart to be unable to pump blood correctly.

Many conditions can cause or contribute to heart failure, such as:

• heart disease
• diabetes
• obesity
• high blood pressure
• valvular heart disease
• familial dilated cardiomyopathy
• toxins, such as alcohol, cocaine, or methamphetamine

The final stage of heart failure is also known as the end stage of heart failure. Doctors classify heart failure into stages A–D and functional classes I–IV to label them in terms of severity and symptoms. These come from the classifications of the American College of Cardiology and the New York Heart Association (NYHA).

According to an older 2007 study, a person with end stage heart failure typically has stage D, NYHA class IV heart failure.

If a person has class IV heart failure, it means they:

• are unable to do any amount of physical activity without experiencing discomfort
• have symptoms of heart failure even when resting
• experience increasing discomfort with any amount of physical activity

If a person has stage D heart failure, it means they:

• have objective (observational) evidence of severe heart disease
• have severe functional limitations
• experience noticeable symptoms even when resting

Learn about the stages of congestive heart failure here.

There is no cure for end stage heart failure. At this stage, people will need to make difficult decisions regarding how much treatment they would like without sacrificing their quality of life. They may also consider palliative or hospice care.

Palliative care

Palliative care aims to improve the quality of life for someone experiencing a life threatening condition.

This may involve treatments to reduce symptoms and address the psychosocial, mental, emotional, or spiritual needs of patients, their caregivers, and their loved ones. It may involve treatments to extend life.

Hospice care

Hospice care does not aim to extend a person’s life, only manage their symptoms. People can only receive hospice care if they agree to no longer take life-prolonging treatments.

Unlike palliative care, which a person can receive according to their needs, hospice care can only help people with around 6 months or less to live.

Medical treatment

Medications for people with advanced heart failure may help them manage their symptoms. They include:

• Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: These reduce levels or actions of angiotensin, which is a hormone that raises blood pressure.
• Beta-blockers: This medication reduces heart rate and “cardiac work.”
• Mineralocorticoid receptor antagonists: This reduces the harmful effects of aldosterone, a hormone that influences blood pressure by controlling the levels of salt and water in the blood.
• Sacubitril/valsartan: This medication blocks the effects of the renin-angiotensin system that controls blood pressure and blood water levels.
• SGLT2 inhibitors: These help reduce the risk of death or hospitalization in people with heart failure.
• Diuretics: These medications increase urine output and remove fluid.
• Hydralazine/isosorbide dinitrate: This helps relax blood vessels and reduce blood pressure.
• Digoxin: This medication increases heart muscle contractions.

Learn more about heart failure medication here.

Some people may also undergo surgery to receive the following:

• Ventricular assist device: This mechanical support device helps the heart pump blood. A person may need a left ventricular assist device, right ventricular assist device, or biventricular assist device.
• Biventricular pacemaker: This device helps the sides of the heart pump blood.
• Implantable cardioverter defibrillator: A device that assesses heart rate and delivers electrical pulses to correct abnormal heart rhythms.

They may also receive an artificial heart or a heart transplant.

Some people may get a peripherally inserted central catheter (PICC) line and receive IV medications at home to decongest the heart or to help support the heart’s pumping while waiting for a transplant.

The best way to help prevent the onset of heart failure is to make behavioral changes or establish habits that reduce the risk of conditions that cause or contribute to heart failure.

Tips for helping to prevent heart failure include:

• eating a cardiac diet
• reducing fat intake
• reducing intake of refined or sweetened foods and drinks
• only consuming alcohol in moderation
• exercising regularly
• staying hydrated
• getting enough sleep
• managing or reducing stress
• treating medical conditions
• not smoking or quitting smoking
• maintaining a moderate body weight
• limiting or reducing intake of heavily processed foods
• reducing sodium intake
• taking medications as the doctor has prescribed
• treating risk factors

End stage heart failure is a chronic condition that does not have a cure. The exact outlook can vary from person to person.

According to a 2018 review, those who have stage D heart failure usually experience a poor quality of life.

People can use medications and other therapies or strategies to help reduce the discomfort that end stage heart failure can cause.

The life expectancy for a person with end stage heart failure will depend on how severe the condition is and how they have responded to treatment.

The mortality rate of end stage heart failure can be as high as 75%. Once heart failure progresses to stage D, people experience poor quality of life and high symptom burden and face a median life expectancy of only 6–12 months.

According to a 2015 review, 38% of people who die due to heart failure do so within a year after diagnosis, and 60% die within 5 years.

People who receive a heart transplant have a 1-year survival rate of 91% and survive for a median of 12–13 years after the transplant.

The survival rates for people who receive a left ventricular assist device after 2, 3, and 4 years are 71%, 62%, and 45%, respectively.

End stage heart disease is the most severe form of heart disease. A person with this condition will need medical intervention to stay alive, often involving a mixture of medications, surgeries, or medical devices.

The symptoms of end stage heart disease include trouble breathing, exhaustion, weight loss, changes in skin color, swelling, and abdominal pain all or most of the time.