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.
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
Devices may be needed to support your heart—left ventricular assist device (LVAD) is one option. It takes over the work of the heart. LVAD is implanted in the upper belly. It may be permanent or short term.
Heart transplant—will depend on your overall health. A donor heart will also need to be available.
Work with your care team to understand your options. Your choice may change over time. Palliative care can help support you throughout your illness. They can also help you communicate your goals to your medical care team. This may include advanced directives that the medical team will follow if you are unable to instruct them.
Hospice care may be needed. The hospice care team specializes in easing pain and suffering from heart failure that can no longer be treated. It may be provided at home or in a care center.
Advanced heart failure cannot always be prevented once heart failure has begun. Following your care plan and healthy habits can delay it.
Heart failure: rehabilitation. EBSCO Nursing Reference Center website. Available at: https://www.ebscohost.com/nursing/products/nursing-reference-center. Updated November 9, 2018. Accessed May 1, 2019.
Case management: the patient with heart failure. American Heart Association website. Available at: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure. Updated April 30, 2017. Accessed April 24, 2019.
Last reviewed May 2020 by EBSCO Medical Review Board
Peter Oettgen, MD
Last Updated: 7/10/2020
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