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 will discuss end stage heart failure, including common signs and symptoms. It will also explain the causes of the condition and how to manage, treat, and help prevent it. It also explores the outlook of people with end stage heart failure.
A person with heart failure experiences weakening of the heart over time. Management and treatment options can help a person live with the symptoms that heart failure causes, but heart failure is chronic, and there is no cure.
In end stage heart failure, the body can no longer compensate for the lack of blood the heart pumps, and the heart has limited functional recovery. A person may find it difficult to breathe even when they are resting.
Stages or classes of heart failure
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).
If a person has class IV heart failure, it
they:
cannot do much 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
Other
of end stage heart failure include frequent ventricular
, worsening
(low blood pressure) due to intolerance to
, weakness and wasting of the heart muscle, deteriorating liver and kidney function, and repeated hospitalizations.
Heart failure can be chronic and develop over time due to medical conditions that make the heart work harder than usual or damage it.
It may also be acute and develop due to conditions that cause sudden damage to the heart, such as heart attack or infection.
Over time, heart failure may progress to the point where medications no longer work. Ventricular assist devices and heart transplants may be an option for some people, but others may not be eligible due to chronic illnesses or certain medical conditions.
Heart failure tends to impact either the right or left side of the heart. 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,
:
valvular heart disease
inherited
toxins, such as alcohol,
, or methamphetamine
There is no cure for end stage heart failure. At this stage, people must decide how much treatment they would like without sacrificing their quality of life.
Some people may wish to seek palliative or hospice care when they are in the final stages of heart failure. This option can help provide great comfort in a person’s last weeks and days.
Medications
Medications may help people with advanced heart failure manage their symptoms. Medications
:
Angiotensin-converting enzyme inhibitors
and angiotensin receptor blockers: These reduce levels or actions of angiotensin, which is a hormone that raises blood pressure.
: This medication reduces heart rate and “cardiac work.”
Mineralocorticoid receptor antagonists: This medication reduces the harmful effects of aldosterone, a hormone that influences blood pressure by controlling salt and water levels.
: This medication blocks the effects of the renin-angiotensin system that controls blood pressure and blood water levels.
SGLT2 inhibitors: These help
the risk of death or hospitalization in people with heart failure.
: 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.
Inotropes: These can include milrinone and dobutamine, which are given via IV continuously for symptom management in advanced heart failure.
Sometimes, people with advanced heart failure cannottoleratethesemedications due to side effects such as
. Intolerance is usually a marker for advanced disease.
Surgery
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: A
helps the heart pump more synchronously for more efficient blood delivery.
Implantable cardioverter defibrillator
: This device 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.
Palliative care
Palliativecare aims to improve the quality of life for someone experiencing a life threatening condition and typically has less than
to live.
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
does not aim to extend a person’s life. It seeks to manage their symptoms and relieve physical and emotional distress so people with end stage heart failure can live as fully as possible with dignity and in comfort at home or in a hospice facility.
There is no cure for end stage heart failure. The exact outlook can vary from person to person. According to a
, 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.
Life expectancy for someone with end stage heart failure
The life expectancy for a person with end stage heart failure will depend on the severity of the condition and how they have responded to treatment.
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
.
According to a
, the average survival rates of people with heart failure are as follows:
86.5% of people with heart failure survive for 1 year
72.6% of people with heart failure survive for 2 years
56.7% of people with heart failure survive for 5 years
34.9% of people with heart failure survive for 10 years.
The overall 5-year survival rate for people with heart failure is around 60%.
A
indicated that 91% of people who receive a heart transplant live for at least 1 year. However, the median survival rate post-transplant is 12–13 years.
According to a
, the survival rates for people who receive a left ventricular assist device after 2, 3, and 4 years are approximately 71%, 62%, and 45%.
Caring for a loved one with end stage heart failure can be challenging but rewarding. It may require a caregiver to provide practical and
. Practical support, for example, may entail helping the person wash or dress.
When caring for someone at the end of their life, the caregiver may find it helpful to:
ask the person’s doctor what they can expect as the illness progresses
ask the doctor about how to manage symptoms
keep contact details for the doctor or healthcare team somewhere accessible or easy to find
keep a record of out-of-hours numbers to contact on evenings and weekends
check what support may be available for them, for example, financial aid or support groups
Caregivers may also wish to discuss hospice care with their loved ones and their healthcare team.
Signs that someone with heart failure is near the end of life
Some physical signs that a person is near the end of their life may include:
on rest or minimal exertion
pain
fatigue or extreme tiredness
limited physical activity
fluid retention
cognitive impairment, like problems with memory, language, speech, or even sudden confusion
nausea and
People with end stage heart failure can experience many different feelings and emotions. They may experience:
sadness
helplessness or as if they have no control over their life
unable to deal with the reactions of others
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, procedures, 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. These can progressively worsen.
Caring for someone with end stage heart failure may involve providing physical and emotional support. Talk with family members about seeking hospice care.