Treatment Options for End-Stage Heart Failure

When you learn that you have advanced or end-stage heart failure, it means the treatments you’ve used in the past no longer work. But there may be other, new ways to manage your condition. Some methods are more aggressive than others. Talk to your doctor about your goals for treatment and quality of life. She can help you make choices that are right for you.

Drugs That Help

Just because the medicine you’ve taken before no longer works, that doesn’t mean there aren’t drugs to help manage your advanced heart disease.

Depending on your condition, you may already be taking a drug to control your blood pressure. Different ones do different things. The most common ones for people with heart failure are ACE inhibitors, ARBs, and beta-blockers. Your doctor may switch you to a new drug or change your dose.

She might pair this medication with a drug called a diuretic. It will help your body shed some of the extra fluid that has gathered in your feet, ankles, legs, or belly. You’ll also breathe easier and be less short of breath if you get treated for fluid in your lungs.

Your doctor could prescribe an IV drug that can help your heart to beat with more force. This treatment isn’t right for everyone, and it may only have short-term effects.

There are many medications to help manage pain. Your doctor will probably want to try an opioid drug like codeine or morphine. You can decide together which one will best suit your needs.

Implanted Devices

Your doctor may suggest surgery to implant a defibrillator in your chest. This device can shock your heart back into a healthy rhythm when it stops beating the right way. If you have a certain type of heart failure, you may have surgery to implant a special heart pump. It helps your heart do a better job of moving blood through your body.

If you feel ill and weak and value quality of life over length of life, you may opt to have your doctor turn it off when you reach end-stage heart failure.

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Heart Transplant

A new heart may improve your symptoms, but not everyone who goes on a transplant waiting list gets one. Other health problems could prevent you from receiving a donor heart. Also, transplant lists are long, with a limited number of hearts from donors, so there may be a long wait.

If you get a new heart, you’ll need to take drugs so your body doesn’t reject it.

Palliative Care

You can tell your doctor that you’d like to have palliative care at any point. It gives pain relief and mental health support to anyone with a serious illness. It’s not the same thing as hospice care, which aims to make you comfortable at the end of life. You must stop efforts to prolong your life once you enter a hospice program. But you can receive palliative care and get treatment to manage your advanced heart failure at the same time.

Pain relief is a big part of palliative care. So is working through your feelings about your health. You may also discuss your end-of-life choices, decide on future treatment options, or attend counseling sessions with family members to help everyone cope with your health issues.

Spell Out Your Choices

It’s smart to let it be known ahead of time what you want to do if your symptoms worsen. Should the doctor try to extend your life at all costs, even if the treatment is painful? Or is your comfort level more important? You probably won’t be able to speak when you need a treatment like CPR, so making formal choices ahead of time can be worthwhile.

The doctor can help you decide if you want to have any of these things done to extend your life:

  • CPR if your heart stops
  • A breathing tube if you can’t breathe on your own
  • A feeding tube if you can’t eat on your own

You may want the doctor to do everything in her power to keep you alive. Or you might have certain standards for quality of life you’d rather meet. You can write those choices down in a formal document called an “advance directive.” Make sure your doctor and family members know your wishes.

WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on September 5, 2017

Sources

SOURCES:

American Heart Association: “Advanced Heart Failure,” “Planning Ahead: Advanced Heart Failure,” “Recognizing Advanced Heart Failure and Knowing Your Options.”

Circulation: “Palliative Care in the Treatment of Advanced Heart Failure.”

Heart: “Management of end stage heart failure.”

American Family Physician: “Diuretics for Treatment of Patients with Heart Failure?”

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