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Advanced Heart Failure

  • Cynthia M. Johnson, MA
Publication Type:


Advanced Heart Failure


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.


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

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

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

Risk Factors

People have a higher risk of advanced heart failure if they 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


Advanced heart failure is 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


The doctor will ask about symptoms and history of heart failure. A physical exam will be done. Blood and urine will be tested to look for changes in other organs like kidneys.

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

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


A new care plan will be needed. It will be based on a person's overall goals. A person may choose aggressive treatment or focus on comfort measures only. These can be hard decisions. Talk to the care team and family about concerns and choices.

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

  • Medicine such as:
    • Diuretics to remove excess fluid in
    • Nitrates to dilate blood vessels
    • Digoxin to help the heart pump
    • Beta-blockers to slow the 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 and vaping
    • Eating healthful foods. Choose foods that are low in fat and sodium
    • Tracking fluid intake
    • Weighing yourself each day to check for extra body fluid

Note: Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen can make this health issue worse. Talk to the doctor about taking other medicines.


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


Surgery is not an option for everyone. It can be harmful for people with weak hearts. Some options that may be needed include:

  • Coronary artery bypass (CABG) surgery—to ease severe blockages in blood vessels. These blood vessels deliver blood to the heart muscle.
  • Devices may be needed to support the heart—left ventricular assist device (LVAD) is one option. It takes over some of the work of the heart. LVAD is implanted in the upper belly. It may be permanent or short term.
  • Heart transplant—will depend on a person's overall health. A donor heart will also need to be available.




  • Acute heart failure. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-heart-failure.
  • 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.
  • Heart failure: rehabilitation. EBSCO Nursing Reference Center Plus website. Available at: https://www.ebsco.com/health-care/products/nursing-reference-center.
  • Life's essential 8. American Heart Association website. Available at: https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8.


  • James P. Cornell, MD
Last Updated:

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.