Advanced Heart Failure

family sitting on couch

Even for advanced heart failure, there are treatment options

When heart failure progresses to an advanced stage, difficult decisions must be made. Do I want to receive aggressive treatment? Is quality of life more important than living as long as possible? How do I feel about resuscitation?

For advanced heart failure patients and their health care professional, making good decisions requires teamwork. Through shared decision-making, health care professionals and patients consider both the options and the patient’s preferences before charting a treatment course. 

What is advanced heart failure?

Of the more than 6 million Americans living with heart failure, about 10% have advanced heart failure. In short, advanced heart failure means conventional heart therapies and symptom management strategies are no longer working. Someone with advanced heart failure feels shortness of breath and other symptoms even at rest.

In the American Heart Association and American College of Cardiology’s A-to-D staging system, advanced heart failure is stage D.

Another classification system, developed by the New York Heart Association, grades the severity of symptoms on a 1-to-4 scale. Your symptom severity number can fluctuate, even within a single day, depending on how you feel. 

In its early stages, medication and a healthy lifestyle can help manage heart failure. But as the disease progresses and the heart becomes weaker, treatment gets more complex. That’s the time to have difficult, yet important, conversations with your family and your health care professional about the care you want to receive. 

What is shared decision-making?

When heart failure progresses to an advanced stage, there are still many treatment options. The decisions, ranging from “do everything possible” to “strive for comfort,” aren’t easy. That’s why the American Heart Association released recommendations that serve as a roadmap to decision-making in advanced heart failure.

The goal? A partnership between you and your health care professional, where medical options are honestly discussed, and decisions are made based on what you want. Shared decision-making means you don’t have to make decisions on your own.

Health care professional-patient conversations about treatment options, their risks and benefits as well as future “what-if” scenarios should happen early and often, according to experts who helped draft the AHA recommendations. This early dialogue means you’re not blindsided when a big medical event happens that requires tough decision-making.

Health care professionals provide the medical facts and figures, while you provide your personal goals and preferences. Together — and often with input from family and friends — you and your health care professional build a care plan.

Living with advanced heart failure is difficult, and the medical decisions can be complicated. With shared decision-making, you can avoid heat-of-the-moment decisions and instead take time to figure out what’s best for you.