Definition

Advanced heart failure is heart failure that has symptoms even with treatment. Symptoms are present even at rest. This is the final stage of heart failure.

Causes

Heart failure starts because of a weakened heart. Over time the increased workload on the weaker heart leads to more heart damage. The weaker heart causes advanced heart failure.

It may be a natural progression of the disease. Other factors that make heart failure worse include:

• Problems with the treatment plan
• Uncontrolled high blood pressure
• A buildup of fluids and sodium

Risk Factors

You have a higher risk of advanced heart failure if you have:

• High blood pressure
• Obesity or are overweight
• Kidney problems
• Taken certain medicines, such as non-steroidal anti-inflammatory drugs (NSAIDs)
• A diet that is high in salt and fat

Symptoms

Advanced heart failure has a worsening of heart failure symptoms, such as:

• Shortness of breath that happens with activity, when lying flat, or when bending down
• Coughing or wheezing
• Lack of energy
• Weight gain from a backup of fluids
• Swelling of the feet, ankles, and legs
• Swollen belly

Diagnosis

You will be asked about your symptoms and history of heart failure. A physical exam will be done. Your blood and urine will be tested to look for changes in other organs like kidneys.

Tests will be done to view your heart and see how it is working. This can be done with:

• ECG
• Ultrasound
• Coronary angiography

An echocardiogram will be done to measure your ejection fraction. This is a measure of how well your heart is pumping out blood. Advanced heart failure will often have an ejection fraction of 40% or below.

Treatment

You and your medical care team will need to make a new care plan. It will be based on your overall goals. You may choose aggressive treatment or focus on comfort measures only. These can be hard decisions. Talk to your care team and family about your concerns and decisions.

Medicine and healthy habits will need to be continued. This may include:

• Medicine such as:
  • Diuretics to remove excess fluid in your body
  • Nitrates to dilate blood vessels
  • Digoxin to help your heart pump
  • Beta-blockers to slow your heart rate and lower blood pressure
  • Calcium channel blockers to lower blood pressure
  • ACE inhibitors to widen blood vessels
• Healthy Habits such as:
  • Not drinking alcohol.
  • Quitting smoking.
  • Eating healthful foods. Choose one that are low in fat and sodium.
  • Tracking your fluid intake.

Note: Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen can worsen your condition. Talk to your doctor about other medicines you may be able to take.

Prevention

Advanced heart failure cannot always be prevented once heart failure has begun. Following your care plan and healthy habits can delay it.