Advanced heart failure

Classes of heart failure

If you are diagnosed with heart failure, you may be given a classification of how severe it is. This is often the ‘New York Heart Association classification of heart failure' (opens new window) (NYHA), which groups people into classes according to the impact of their heart failure.

• Class I (unaffected): activities are unlimited, and ordinary activity doesn’t cause symptoms.
• Class II (mildly affected): activity is limited a little. Activities such as walking up several flights of stairs causes symptoms such as tiredness, palpitations and breathlessness.
• Class III (moderately affected): activity is more limited than class ll. Symptoms happen with activities such as walking on a flat surface.
• Class IV (severely affected): activity is very limited. Symptoms happen with all activity, and the person is breathless even when resting.

Options for surgery

• Heart valve repair or replacement – if the valves are damaged and affect the heart’s function, they may be repaired or replaced to help improve symptoms.
• LVAD (Left ventricular assist device) – this mechanical device helps the heart to pump blood out of the left ventricle (main pumping chamber of the heart) when it is not working properly. This is currently only used to support the heart while waiting for a transplant.
• Angioplasty and bypass surgery – this is used where heart failure is caused by coronary heart disease. The arteries may need to be widened (using an inflatable balloon to stretch them during angioplasty) or the blood supply to the heart diverted around the blockage using a blood vessel from somewhere else in the body (bypass surgery). (This is not usually used when heart failure is caused by cardiomyopathy.)

Implanted Devices 

When it comes to end of life care you may need to consider whether your ICD is still appropriate or whether to turn it off so that it no longer paces your heart or gives life-saving shocks.

In this case, the ICD can be deactivated, where it is programmed to stop working. The device itself will be left in place. This can be a very difficult decision, and it may be something that you want to discuss in advance with your family and with your healthcare team.