Advanced heart failure is when you have heart failure that’s getting worse, even though you’re taking standard medications and making lifestyle changes. It’s not a different disease; it’s a more advanced form of heart failure.
The American Heart Association and the American College of Cardiology use these four stages to describe heart failure:
Stage A: At risk for heart failure
Stage B: Pre-heart failure
Stage C: Symptomatic heart failure
Stage D: Advanced heart failure
The New York Heart Association (NYHA) separates stage C and stage D into four levels, or classes:
Class 1: Your heart failure doesn’t limit your physical activity. With ordinary physical activity, you don’t notice much fatigue, palpitations (rapid heartbeat) or shortness of breath.
Class 2: You start to notice limits to what you can do. You may be comfortable at rest, but ordinary physical activity may cause fatigue, palpitations, shortness of breath or chest pain.
Class 3: You’re comfortable at rest but even a small amount of activity may cause fatigue, palpitations, shortness of breath or chest pain.
Class 4: You have symptoms at rest and activity makes them worse.
What symptoms may signal that heart failure is getting worse?
Even when you’re on the right heart failure medications, you may still notice signs of worsening heart failure such as:
Feeling tired or weak, even with small amounts of activity
Shortness of breath when you’re resting or lying down
Being hospitalized due to too much fluid in your lungs
Loss of appetite
Unexpected weight loss Swelling in your legs, ankles or abdomen
What are common risk factors for advanced heart failure?
Common risk factors include:
Unmanaged heart failure symptoms
Refractory coronary artery disease (long-term chest pain that lasts even after you’ve tried medication and surgery)
Having one or more heart attacks in the past
Uncontrolled or poorly controlled high blood pressure
Uncontrolled or poorly controlled diabetes
Metabolic syndrome, which is when you have three or more of these conditions: too much fat at the waist, high cholesterol, high triglycerides, high blood pressure or high blood sugar
Obesity
Untreated heart valve disease
Cardiomyopathy, a disease where it’s hard for your heart to pump blood
Not taking medications as you are supposed to or not following your care plans
Refractory arrhythmias, which are heart rhythm problems that don’t go away with treatment, like persistent atrial fibrillation (AFib)
How is advanced heart failure diagnosed?
To diagnose advanced or treatment-resistant heart failure, your health care provider will ask you to track your symptoms and will check your health.
They may order:
Echocardiogram: This test can measure your ejection fraction, which shows how well your heart is pumping blood.
Cardiac MRI: This imaging test can show how much damage there is to your heart.
Blood tests: High levels of B-type natriuretic peptide (BNP) and N-terminal pro B-type natriuretic peptide (NT-proBNP) can be a sign of advanced heart failure.
Left heart catheterization: This test checks the arteries that bring blood to your heart for blockages.
Right heart catheterization: This test can measure blood pressure in your heart and lungs.
Cardiopulmonary exercise stress testing: This test can help determine how severe your heart failure is.
Left ventricular assist device (LVAD): A battery-operated pump that helps your heart pump blood to your body
Total artificial heart (TAH): A pump that replaces your heart to send blood through your body and make sure your organs get enough blood until you can get a heart transplant
Temporary heart pumps: Other assist devices that help circulate your blood until you can get other treatment, like transplant
If you have advanced heart failure, you may qualify for a heart transplant. This depends on the condition of your heart, your overall wellness, your age, your blood type and more.
You may also choose palliative care, which can help reduce your pain and symptoms and give you a sense of control over the care you get.
When should you seek advanced heart care?
Ask your cardiologist for a referral to a Banner Health advanced heart care specialist if:
You have Class 3 or 4 heart failure symptoms
You’ve been hospitalized for heart failure once or more in the last year
Your ejection fraction is low even though you’re following your treatment plan
You can’t tolerate medications, so your provider is reducing them
Your quality of life is poor
What support can you get from Banner Health’s care team?
Care for advanced heart failure at Banner Health includes:
Specialized heart failure clinics
Experts in heart transplant and MCS
Nutrition, medication and emotional support services to help with all the ways advanced heart failure impacts your life
Case management and remote monitoring so your care team is up to date on any changes in your symptoms or condition
Patient navigators who can help you with complex care plans
Cardiac rehabilitation
FAQs and related resources
What is the difference between heart failure and advanced heart failure?
Heart failure is when your heart is weak or stiff and can’t pump blood properly. Advanced heart failure is when your symptoms keep getting worse, even though you’re following your treatment plan for heart failure.
How do I know if I need a heart transplant?
You may need a heart transplant if the treatments you’ve tried for advanced heart failure aren’t working, so your quality of life and life expectancy are reduced.
How do I know if I qualify for a heart transplant?
To find out if you qualify, a team that may include a cardiologist, surgeon, social worker, nutritionist, behavioral health specialist and other experts will recommend tests and screening exams.
What are my options if I’m not a heart transplant candidate?
If you don’t qualify for a heart transplant, you may be able to use an LVAD or have other surgeries that may help your heart work better.
How do I know if I qualify for an LVAD?
Your health care team can help you find out if you qualify for an LVAD. Generally, you need to have class 3 or 4 heart failure. Having some other health conditions, like liver, kidney, lung or blood clotting problems, may mean you don’t qualify for an LVAD.
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