Final Stages of Heart Failure: End-Stage Heart Failure (2023)

Final Stages of Heart Failure: End-Stage Heart Failure (1)

Blog: Stories and Insight

Final Stages of Heart Failure: End-Stage Heart Failure (2)If you or a loved one have heart failure, it’s important to plan for the future. By knowing what to expect, you’ll be able to make the best decisions about your care and ensure that your needs and wishes are met.

Treatments and lifestyle changes can help people live well with heart failure and delay its progression. Even in the final stages of heart failure, proper care can keep people comfortable and help them make the most of their remaining time.

What is End-Stage Heart Failure?

Heart failure is a gradual weakening of the heart, which prevents the heart from pumping as well as it should. Over time, the condition causes other damage to the body.

Final Stages of Heart Failure: End-Stage Heart Failure (3)At first, the heart compensates for its weakness by changing: it may stretch, enlarge, and pump faster. The body also changes, narrowing blood vessels and diverting blood from certain organs. (As a result, many people are not even aware they have a problem during the early stages of heart failure.)

Despite these adjustments, heart failure will continue to worsen, and the body will eventually be unable to compensate for the lack of blood flow. At that point, the person may start experiencing fatigue, breathing difficulties, and other issues.

Various treatments can help people manage these symptoms and slow the disease’s progression. However, heart failure is a chronic condition with no cure. Over time, patients will reach the final stages of heart failure.

During these late stages, the person feels breathless even while resting. However, the severity of their symptoms can fluctuate over days or hours.

(Video) Stages of Congestive Heart Failure - Stage D (End-Stage)

What are the Symptoms of End-Stage Heart Failure?

Heart Failure: Quick Facts

1. More than 6 million U.S. adults have heart failure.

2. About half of people who develop heart failure die within 5 years of diagnosis.

3. Most people with end-stage heart failure have a life expectancy of less than 1 year.

4. The leading causes of heart failure are diseases that damage the heart, such as heart disease, high blood pressure, and diabetes.

Sources: U.S. Centers for Disease Control and Prevention, American Heart Association, National Institutes of Health.

Heart failure worsens over time, so symptoms are most severe during the final stages. It causes fluid to build up in the body, which produces many of these symptoms:

(Video) What is Stage D Heart Failure?

  • Shortness of breath (dyspnea). In the final stages of heart failure, people feel breathless both during activity and at rest.
  • Persistent coughing or wheezing. This may produce white or pink mucus. The cough may be worse at night or when lying down.
  • Weight gain or swelling (edema) of the feet, ankles, legs, abdomen, or neck veins.
  • Tiredness, weakness.
  • Lack of appetite, nausea.
  • Thinking difficulties, confusion, memory loss, feelings of disorientation.
  • Increased heart rate, feeling like your heart is racing or throbbing.
  • Frequent urination.

In addition, people in the final stages of heart failure may suffer from:

  • depression, fear, insomnia, and isolation
  • anxiety about their future
  • trouble navigating the health care system

Treatment of End-Stage Heart Failure

Final Stages of Heart Failure: End-Stage Heart Failure (4)Treatments, such as medications and healthier lifestyles, can help people with heart failure live longer, more active lives. Palliative care – which increases comfort and reduces symptoms – can be given alongside other medical treatments.

Some people with end-stage heart failure may also benefit from implanted devices that help the heart pump blood, or from a heart transplant. However, such invasive treatments also carry risks and potential downsides.

It’s important to understand your options – and to have conversations with your doctor and family about the types of care you want to receive. People with heart failure can have many choices to make, even during the final stages. Moreover, your physician or palliative-care provider can help you plan for potential health emergencies and make treatment decisions in advance instead of during a crisis.

When a patient has a life expectancy of six months or less, they become eligible for hospice care – a type of palliative care given at the end of life. Hospice provides extra support and services to help the person live comfortably and have the best possible quality of life. Hospice providers can also help the patient and family plan for future needs and possible scenarios. They have unique expertise in assisting people with these issues.

” Patients with heart failure can deteriorate quickly or die suddenly, so it’s important to discuss end-of-life issues early and often.” ~ Dr. Stephen Goldfine, Chief Medical Officer, Samaritan Healthcare & Hospice

When to Seek Hospice Care

Final Stages of Heart Failure: End-Stage Heart Failure (5)Even physicians have difficulty determining life expectancy for people with end-stage heart-failure. The condition can be unpredictable, and symptoms can change. However, certain signs can indicate that hospice care would be beneficial, including:

  • frequent chest pain (angina)
  • abnormal heart rate
  • significant fatigue or shortness of breath
  • substantial decline in ability to do daily activities, such as self-care
  • The patient has already received the best possible treatment(s), which are no longer working well, and the patient is not a candidate for other interventions.
  • The patient has received the best possible treatment(s) and has decided to decline further specialized interventions.

People can be reluctant to start hospice, as they may worry it means they’re “giving up” or that it will hasten death. But such concerns are unfounded. In fact, patients and families often wish they had started hospice sooner, because it makes such a positive difference in their lives. And research shows that early admission to hospice results in greater satisfaction with care among patients and family caregivers.

(Video) Caregivers of Patients with End Stage Heart Failure / Health Care Outlook featuring Martha Abshire

How Palliative and Hospice Care Can Help with End-Stage Heart Failure

Final Stages of Heart Failure: End-Stage Heart Failure (6)Both palliative and hospice care focus on the whole person, including their physical, emotional, social, and spiritual needs. The main difference is that palliative care can be given at any time during a serious illness, and hospice care is given near the end of life – typically when a person’s prognosis is six months or less. (Hospice is a form of palliative care.)

Palliative and hospice care can also provide help with making difficult treatment decisions, such as whether to be resuscitated if the person’s heart stops, or whether to have a tube placed in their throat to help them breathe.

Similarly, people with end-stage heart failure may need to decide when to disable certain medical devices implanted in their body:

  • Implantable cardioverter defibrillator (ICD). Patients can have the shock function turned off, or not replace the battery when the current one runs out. Electrical shocks from ICDs can cause unnecessary distress for patients and loved ones at the end of life.
  • Left ventricular assist device (LVAD). Typically, the patient decides when this heart pump will be shut off before it is implanted. The decision can be discussed again as the end of life nears. (Unlike with ICDs, LVAD discontinuation can cause rapid changes that can quickly lead to death.)

Learn more about hospice care here.

Final Stages of Heart Failure: End-Stage Heart Failure (7)In addition, the palliative or hospice team can assist with navigating insurance issues, creating advance directives (such as a living will), and other practical matters. And they can support family caregivers through education, respite services, and grief counseling.

Palliative and hospice care can relieve suffering from heart-failure symptoms, including pain, breathlessness, depression, insomnia, and fear. This can be done through medication, therapies, counseling, and other supports. Hospice and palliative care can help a patient feel at peace, emotionally and spiritually. And hospice can enable a serene and dignified death.

The palliative or hospice team can include a physician, nurse, social worker, certified home health aide, spiritual support counselor, trained volunteers, bereavement support, and complementary therapies such as massage. The team works with the patient and family to create a personalized care plan, based on the patient’s needs, goals, and preferences.

Hospice care is typically given where the patient lives – whether at home or in an assisted living facility or nursing home. Hospice can also be provided in a patient’s hospital room or in a dedicated hospice facility. A key benefit of hospice is that it often enables the person to die at home, which is the wish of most people.

(Video) Matt's Story - From End-Stage Heart Failure to Recovery Video - Brigham and Women's Hospital

People with end-stage heart failure and their families face a complex journey. But help is available so patients can get the right care at the right time, and live each day to its fullest potential.

If you live in South Jersey and have questions about
end-stage heart failure or hospice care for your loved one, please call Samaritan at (800) 229-8183.

(Video) 1.1 End-Stage Heart Failure_Dominique Bettex


How do you know when heart failure is near the end? ›

In the final stages of heart failure, people feel breathless both during activity and at rest. Persistent coughing or wheezing. This may produce white or pink mucus. The cough may be worse at night or when lying down.

How long does end stage heart failure last? ›

Patients are considered to be in the terminal end stage of heart disease when they have a life expectancy of six months or less. Only a doctor can make a clinical determination of congestive heart failure life expectancy.

What happens at end stage heart failure? ›

In end stage heart failure, the body can no longer compensate for the lack of blood the heart pumps, and the heart has limited functional recovery. A person may find it difficult to breathe even when they are resting.

Does end stage heart failure mean death? ›

If a patient has end-stage heart failure it means they are at high risk of dying in the next 6 to 12 months. These are the common symptoms of end-stage heart failure: pain. breathlessness on minimal exertion or at rest.

Is End of Life heart failure painful? ›

Common symptoms in end-stage heart failure include:

Pain. Breathlessness. Persistent cough. Fatigue.

What are the signs that heart failure is getting worse? ›

Fatigue and Activity Changes

The easiest way to know that heart failure is getting worse is you're able to do less and less. People start pacing themselves. They stop doing hobbies that involve any physical activity. They used to go fishing, but not anymore.

How long does end stage life last? ›

The active stage of dying generally only lasts for about 3 days. The active stage is preceded by an approximately 3-week period of the pre-active dying stage. Though the active stage can be different for everyone, common symptoms include unresponsiveness and a significant drop in blood pressure.

Is Stage 4 heart failure the last stage? ›

In Stage 4, symptoms will worsen for the patient and will not improve with treatment. This is the final stage of congestive heart failure.

How quickly does heart failure progress? ›

Symptoms can develop quickly (acute heart failure) or gradually over weeks or months (chronic heart failure).

What happens in the final stage of dying? ›

During the final stage of dying, disorientation and restlessness will grow. There will be significant changes in the patient's breathing and continence.

How is end of life diagnosed? ›

People are considered to be approaching the end of life when they are likely to die within the next 12 months, although this is not always possible to predict. This includes people whose death is imminent, as well as people who: have an advanced incurable illness, such as cancer, dementia or motor neurone disease.

Can heart failure deteriorate quickly? ›

Heart failure, which means your ticker can't pump as well as it should, can sometimes quickly get worse. In that case, it's called acute or sudden heart failure. To prevent it from happening to you, watch for the warning signs that your heart failure is getting worse.

Why does your stomach swell when you have congestive heart failure? ›

Swelling or pain in the upper abdomen (stomach area) can occur due to fluid build-up (congestion) in the body, which is a sign of worsening heart failure. The discomfort is due to fluid retention and congestion in the liver and gut.

Can congestive heart failure worsen suddenly? ›

Heart failure can suddenly get worse due to: Ischemia (lack of blood flow to the heart muscle) Eating high-salt foods. Heart attack.

How do you know when someone is transitioning to death? ›

Often before death, people will lapse into an unconscious or coma-like state and become completely unresponsive. This is a very deep state of unconsciousness in which a person cannot be aroused, will not open their eyes, or will be unable to communicate or respond to touch.

What happens in the last few weeks of life? ›

Nearing the end of life

Everyone's experiences are different, but there are changes that sometimes happen shortly before a person dies. These include loss of consciousness, changes to skin colour, and changes to breathing.

What happens in the final moments before death? ›

Physical signs

Facial muscles may relax and the jaw can drop. Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing. Towards the end, dying people will often only breathe periodically, with an intake of breath followed by no breath for several seconds.

What stage of heart failure is shortness of breath? ›

Stage 2 of Congestive Heart Failure

Stage two of congestive heart failure will produce symptoms such as fatigue, shortness of breath, or heart palpitations after you participate in physical activity. As with stage one, lifestyle changes and certain medication can help improve your quality of life.

What stage is severe heart failure? ›

Stages of heart failure

The stage describes how severe your heart failure is. It's usually given as a class from 1 to 4, with 1 being the least severe and 4 being the most severe: class 1 – you don't have any symptoms during normal physical activity.

Can heart failure affect the bowels? ›

Some of the symptoms and treatments of heart failure may lead to bladder and bowel problems such as: frequently passing urine in the toilet (frequency) i.e. more than 8 times a day. feeling a sudden, strong desire to pass urine (urgency) leaking urine while rushing to the toilet (urge incontinence)

What is considered advanced heart failure? ›

Advanced heart failure (HF) occurs when patients with HF experience persistent severe symptoms that interfere with daily life despite maximum tolerated evidence-based medical therapy.

Is it normal to sleep a lot with heart failure? ›

Conclusions: Patients with CHF who develop CSR experience excessive daytime sleepiness due to sleep disruption. This should be considered the clinical evaluation of these patients' daytime complaints.

What does a heart failure cough sound like? ›

You may experience a persistent cough or wheezing (a whistling sound in the lungs or laboured breathing) due to your heart failure.

How long does heart failure last in elderly? ›

While advancements have been made, according to a 2008 study, 50% of patients will have an average life expectancy of five years. For those with advanced heart failure, up to 90% will pass away within one year.

How long can you live with advanced heart failure? ›

Without using therapies promoting reverse remodeling, 35% of patients with severe HF will die within one year [24,25]. While median survival following diagnosis of HF is 1.7 years for men and 3.2 years for women, around 75% of patients die within 5 years of diagnosis of HF [26].

Does heart failure cause immediate death? ›

When the heart stops, the lack of oxygen-rich blood can cause death or permanent brain damage within minutes. Time is critical when you're helping an unconscious person who isn't breathing. If you see someone who's unconscious and not breathing normally, do the following: Call 911 or emergency medical help.

Can heart failure deteriorate suddenly? ›

Heart failure can be ongoing (chronic), or it may start suddenly (acute). Heart failure signs and symptoms may include: Shortness of breath with activity or when lying down. Fatigue and weakness.

Do oxygen levels drop with heart failure? ›

With heart failure, your heart becomes a weaker pump. Over time it becomes less effective at pumping oxygen-rich blood through your body. This may cause your oxygen levels to drop. When oxygen levels drop, you may become short of breath or winded.

How long can an 83 year old live with congestive heart failure? ›

A report averaging several smaller studies found that people under age 65 generally had a 5-year survival rate of 78.8 percent following CHF diagnosis. The same report found that people over age 75 had an average 5-year survival rate of 49.5 percent following diagnosis.

What is the difference between heart failure and advanced heart failure? ›

Advanced heart failure is a form of heart failure that has progressed to the most serious stage. Heart failure gets worse over time. There are four main heart failure stages, based on a patient's risks and symptoms. Patients who have advanced heart failure are in the most severe stage of the disease.

What is class 4 heart failure? ›

Objective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.
Classes of Heart Failure.
ClassPatient Symptoms
IVUnable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.
3 more rows
31 May 2017


1. Ask the Expert: Advanced Heart Failure
2. Advanced Heart Failure: Katina Williams' Story
(MedStar Health)
3. Heart Therapies for End Stage Heart Disease
(AdventHealth Florida)
4. What is end stage heart failure? - Dr. Mohammed Haroon Rashid
(Doctors' Circle World's Largest Health Platform)
5. The stages of heart failure
(American Heart Association)
6. Heart failure treatment - Late stages | Circulatory System and Disease | NCLEX-RN | Khan Academy
Top Articles
Latest Posts
Article information

Author: Nicola Considine CPA

Last Updated: 11/27/2022

Views: 5666

Rating: 4.9 / 5 (49 voted)

Reviews: 80% of readers found this page helpful

Author information

Name: Nicola Considine CPA

Birthday: 1993-02-26

Address: 3809 Clinton Inlet, East Aleisha, UT 46318-2392

Phone: +2681424145499

Job: Government Technician

Hobby: Calligraphy, Lego building, Worldbuilding, Shooting, Bird watching, Shopping, Cooking

Introduction: My name is Nicola Considine CPA, I am a determined, witty, powerful, brainy, open, smiling, proud person who loves writing and wants to share my knowledge and understanding with you.