Heart failure – advanced

Although treatment helps to control heart failure symptoms, heart failure gets worse over time. Treatment becomes less effective and your daily life is affected.  

Symptoms of advanced heart failure may include that you: 

• are very short of breath despite not moving much or even when you're resting, even though you are taking quite a few medicines
• need more help with day-to-day chores, such as getting dressed, preparing meals or washing yourself
• lose your appetite 
• feel weak, have no energy and feel very tired
• have lots of hospital admissions for heart failure or need to see your healthcare provider multiple times
• are losing weight 
• stay in bed most of the time and move around less. 

If you have advanced heart failure, it's likely that you won't get any better. Your doctor or nurse practitioner will suggest changing the goal of your treatment to making sure you're living in comfort and to improving your quality of life rather than making your life longer. This is called palliative care.  

Palliative care aims to manage any symptoms you may have and helps you and your whānau make decisions about how you wish to spend the rest of your life. Your healthcare provider might provide your care, if they are experienced in this, or refer you to a palliative care team. Read more about palliative care and palliative care and planning.

It's a good idea to plan your future health care and end-of-life care to help prepare you and your whānau for what the future holds. This is especially helpful if you can no longer speak for yourself, such as if you get very sick. It also helps your healthcare team know what health care you want or don't want. This is known as advance care planning. It includes deciding about resuscitation(external link). 

Image credit: Canva

If you have advanced heart failure and are towards the end of your life, your healthcare provider may talk with you about stopping some of your heart failure medicines if they are no longer managing your symptoms well. 

Instead, they may prescribe medicines to relieve your symptoms, such as:

• pain relief medicines to control your pain
• morphine or benzodiazepines to control your breathlessness
• antiemetics if you have nausea (feeling sick) or vomiting 9being sick)
• laxatives if you have constipation. 

Read more about common symptoms in palliative care. 

This is a good time to appoint an enduring power of attorney (EPA) and make a will through your lawyer.

If you have an implantable device such as a defibrillator or pacemaker, your healthcare provider will discuss having this turned off. 

The Heart Foundation NZ(external link) provides resources and support for those living with a heart condition. You can also find a local support group(external link) in your area. Contact them using their online form(external link) or visit their website(external link).

Extra support is also available if you need it. Talk to your healthcare team to find out how you can access this.

It includes:

• equipment to help with your daily chores, such as chair raisers and shower stools
• mobility parking and taxi vouchers to help you get around your community
• carer support to help support a carer who is looking after you – read more about how to access carer support(external link)
• funding for medical costs, such as a community services card
• counselling or mental health support
• needs assessment if you want to move into a rest home or other residential care.