What are the options for end stage heart failure?

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People with end stage heart failure have symptoms of heart failure when they are resting. These can include:

• shortness of breath
• fatigue
• persistent coughing or wheezing
• swelling in the legs, feet, and ankles, or in the abdomen due to a buildup of fluid
• lack of appetite
• nausea
• confusion, disorientation, or memory loss due to changes in sodium levels
• increased heart rate

Treatment cannot cure end stage heart failure. It can help support the heart to function and reduce symptoms. Treatment can help improve a person’s quality of life and may help them live longer.

The goals of treatment can be individual to each person. People may need to decide their priorities are and consider each treatment option’s risks and benefits.

Treatment options for advanced heart failure involve addressing the underlying cause of heart failure, reducing symptoms, and lowering the risk of sudden death. They may include:

• Open heart surgery: In open heart surgery, a surgeon temporarily stops the heart and then restarts it. It is unclear whether this surgery is an effective treatment for advanced heart failure. Types of surgery include repairing or replacing a damaged heart valve or creating a bypass around blocked arteries. A surgeon may perform other types of heart surgery depending on the cause of heart failure.
• Percutaneous interventions: These are nonsurgical procedures that a surgeon performs on a beating heart to repair valves or open a blocked artery. They access the heart by inserting tools through an opening made in the groin.
• Pacemaker: Heart failure can affect heart contractions. A pacemaker can help the pumping chambers of the heart contract regularly.
• Implantable cardioverter defibrillator (ICD): If the heart beats in an irregular rhythm, an ICD shocks the heart to restore its regular rhythm. An ICD does not reduce symptoms, though it may lower the risk of sudden cardiac death.

Short-term therapies

People may require short-term treatments for other conditions that may co-occur with heart failure, such as acute kidney failure. Doctors may recommend the following therapies while people wait for heart surgery. Some people may require these therapies over a long period.

• Intra-aortic balloon pump: A surgeon places a small balloon inside the heart’s main artery and uses a machine to inflate it. This helps to increase blood flow to the heart and reduce how hard the heart has to work.
• Left ventricular assist device (LVAD): An LVAD helps support the left chamber of the heart in pumping blood to the body.
• Extracorporeal membrane oxygenation (ECMO): An ECMO machine increases the oxygen level in the blood, which then circulates the body.
• Positive inotropic drugs: These are drugs people receive through an IV to help increase the force with which the heart beats.
• Renal replacement therapy: Advanced heart failure can negatively affect the kidneys, which may lead to kidney failure. Treatments such as dialysis can help the body remove excess fluid and waste products from the blood.

Heart transplant

A heart transplant replaces a heart that is not functioning correctly with a healthy heart from a donor. A heart transplant may ease symptoms of heart failure.

People who have a heart transplant will need to take immunosuppressive medications daily to prevent the body from rejecting the new organ. These medications can cause side effects, such as high blood pressure, kidney disease, and diabetes.

According to a 2019 article, a heart transplant may be the best treatment option for most people with advanced heart failure. However, there is a limited supply of donor hearts, so people may have to consider waiting times as well as the risks involved.

Palliative care is a specialized form of care that focuses on medical treatment for symptoms of a condition and improving quality of life. A person can receive palliative care and continue treatment for heart failure.

People with end stage heart failure may receive palliative care in a hospital, nursing home, or at home. Health insurance may cover the costs of palliative care.

Learn about whether Medicare covers palliative care here.

Hospice care is an option for people with serious illnesses who are reaching the end of their life.

Hospice care does not continue to treat a condition. Instead, it focuses on making a person as comfortable as possible and ensuring they have the best quality of life possible.

When to seek hospice care

People may have hospice care if a doctor believes they may have 6 months or less to live.

People may seek hospice care if their heart failure is no longer responding to treatments or if they no longer want to continue treatments.

People can discuss hospice care with a healthcare professional. Planning for hospice care may help people have the care and support they require and quality time with loved ones. Hospice care can take place in a hospice, nursing home, hospital, or at home.

Learn more about the difference between hospice and palliative care here.

The American Heart Association (AHA) recommends that people prepare questions and know their preferences and treatment goals before speaking with a doctor.

This can help people get the most out of their visit and ensure they get the best treatment for their condition and preferences.

The AHA recommends asking a doctor questions such as:

• Will you speak with me honestly and openly about my condition?
• Will you help me decide on care that suits my preferences and goals?
• What decisions do I need to make about future care?
• What are the benefits and risks of certain treatments?
• How might my symptoms progress based on my current situation?
• What can I expect as the outlook?
• Can we schedule future appointments to discuss my goals and treatment decisions?

Below are places that people with heart failure and their loved ones may find support.

• PREPARE for your care: An organization to help people make care and medical decisions.
• Heart failure tools and resources: The AHA provides information and resources for people with heart failure.
• Caregiver support: The AHA provides resources to help caregivers.
• Heart failure resources: The Heart Failure Society of America provides information and support resources, including patient assistance programs.

Treatments for end stage heart failure may help ease symptoms and improve quality of life, and may help lengthen life.

Treatment options will depend on an individual’s condition and personal preferences and goals.

People may want to discuss the risks and benefits of heart failure treatments with a healthcare professional and take time to consider future decisions around treatment and care.