Advanced heart failure occurs when your heart failure continues to worsen despite your taking medicines and following other measures (like diet changes) to manage your condition.

Heart failure with reduced ejection fraction means your heart isn’t pumping enough blood through your body for your organs to work as well. You may often feel shortness of breath, experience swelling, and have a hard time doing daily activities.

If your heart failure progresses to advanced heart failure, it’s important you get the right experts in your corner so you can enjoy a better quality of life.

Keep reading to find out more about what advanced heart failure is and how doctors treat the condition.

Several trusted medical organizations have defined heart failure and advanced heart failure symptoms. Because there are multiple definitions available, it’s challenging to have just one set of symptoms that mean you’re in advanced heart failure.

However, some of the commonly listed symptoms from organizations like the Heart Failure Society of America, American Heart Association (AHA), and American College of Cardiology (ACC) include:

  • shortness of breath with activity
  • damage to major organs, such as the kidneys, brain, or eyes from poor circulation
  • fluid retention (swelling) that doesn’t get better with diuretic medicines
  • reduced ejection fraction of less than 40 percent
  • frequent episodes of low blood pressure
  • more than two hospitalizations a year for heart failure-related symptoms

Your doctor can also order blood testing to test for the presence of substances in your blood that indicate your heart is failing. This testing can help your doctor determine how severe your heart failure is.

Doctors will often consider a patient’s symptoms and “stage” their heart failure. Using heart failure stages helps doctors convey to other healthcare professionals how severe heart failure is and what treatments a person may need.

There are two main heart failure staging systems:

  • the ACC/AHA
  • the New York Heart Association (NYHA)

Examples of their stages include:

ACC/AHA stages

  • A: Patient is at high risk for developing heart failure but has no functional or structural heart disorder.
  • B: structural heart disorder without symptoms
  • C: past or current symptoms of heart failure associated with structural disorder
  • D: advanced heart disease requiring hospital-based support, transplant, or palliative care

Those with advanced heart failure would fall in category D.

NYHA stages

  • I: no limitation to normal physical activity
  • II: mild symptoms with normal activity
  • III: markedly symptomatic during daily activities, asymptomatic only at rest
  • IV: severe limitations, symptoms even at rest

Those with advanced heart failure would have Class III or Class IV symptoms.

When you have advanced heart failure symptoms, your doctor may recommend testing to:

  • determine how effectively your heart is pumping
  • measure the pressures in your heart

One way to do this is called a right heart catheterization, in which a doctor threads a special catheter through an artery in your wrist or leg to measure your heart’s pressures.

Your doctor will likely prescribe a number of medications to treat heart failure. These medicines work to reduce how hard the heart has to work to pump blood. Some of these medicines include beta-blockers and chemical blockers called RAAS system blockers and SGLT2 inhibitors.

If your heart failure is very advanced and your body is moving very little blood through, a doctor may recommend a temporary mechanical circulatory support device. You may also need special medications delivered via an IV to help your heart pump better.

Different kinds of devices can help your heart pump harder. The device selected usually depends on your heart’s pressures and overall health. The following table explains some mechanical circulatory support devices.

Device name What it does Who cannot use the device (contraindications)
Intra-aortic balloon pump (IABP) a device that involves inserting a catheter in the groin and having an external pump that helps to move more blood out from the heart • severe peripheral artery disease (PAD)
• history of abdominal aortic aneurysm (AAA)
• significant aortic insufficiency (AI)
Impella a device that involves inserting a catheter in the groin and advancing it to your heart where it helps move blood out of your heart’s ventricle to the body • known blood clot (thrombus) in the left ventricle
• significant AI
• mechanical aortic valve
• severe PAD
Tandemheart a device that increases the heart’s blood output by bypassing the left ventricle (part of the heart that pumps blood out to the body) • ventricular septal defect (VSD)
• significant AI
• left atrial blood clot (thrombus)
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) This device is a special form of heart support that manages the work of the heart and lungs. • severe PAD
• significant AI
• aortic dissection

These are all temporary devices meant to help your heart pump while your medical team decides how to best treat you. A doctor will likely evaluate you for more invasive methods to maintain your heart’s output. Examples of these treatments include:

  • Left ventricular assist device (LVAD). This is a device implanted in the chest to help pump blood out of your heart. You have to wear a battery pack and control unit when you have an LVAD.
  • Heart transplant. This option is where surgeons replace your heart with a donor heart. You’ll have to complete an extensive work-up to make sure your body can handle the heart transplant and also have an available donor heart.

These are options for long-term management of advanced heart failure.

However, if you do not wish to undergo these procedures, you have other options. Your doctor can also discuss supportive care called palliative care, which can make you more comfortable when you have advanced heart failure.

Are treatments for advanced heart failure covered by insurance or Medicare?

Medicare covers ventricular assist devices like the LVAD and heart transplantations, providing a doctor certifies the patient is a good candidate for the device. While insurance company coverage may vary, many insurers will follow the coverage policies of Medicare.

However, you should check with your insurance company regarding coverage for heart failure and medications you take for heart failure.

An estimated 6.2 million people in the United States live with heart failure. It’s difficult to estimate just how many people have advanced heart failure because there are different definitions of the condition.

However, smaller studies estimate advanced heart failure may occur anywhere from 0.2 to 5 percent of the population.

An estimated 75,000 people in the United States died from advanced heart failure in 2015. Of those who don’t use therapies like an LVAD or a full medication regimen, an estimated 35 percent of patients with severe heart failure will die within a year.

Living with advanced heart failure

Advanced heart failure not only affects your body. It can also cause you significant anxiety, worry, and depression. Seeking support from friends, family, and even support groups can help. Some resources include:

  • AHA, which offers in-person and online support groups
  • Mended Hearts, a nonprofit organization that provides support to those with heart conditions
  • There are also online support groups on social media sites, such as Facebook. These support groups are online-specific and may be involved with a hospital or healthcare organization.
  • Ask your doctor or cardiac rehab team if they know of any local support groups in your area.

Advanced heart failure is a life-affecting condition that has an unpredictable course.

However, outcomes and treatments are improving regularly to help you live a longer and more satisfying life. It’s important to make sure you understand your heart failure and ask your doctor questions about potential treatments.