Refractory Congestive Heart Failure

When congestive heart failure is particularly severe and not responding to medication, the condition is called refractory congestive heart failure. People with this condition can generally expect symptoms to get worse and eventually lead to death. However, people with very severe cases of refractory congestive heart failure may be considered for a mechanical heart pump or a heart transplant.

 

Refractory Congestive Heart Failure: An Introduction

Refractory congestive heart failure (CHF) is a severe type of heart failure. In refractory CHF, even though a person is on the highest doses of medication, he or she still has severe symptoms and repeated hospitalizations or emergency visits.
 

Treatment for Refractory Congestive Heart Failure

Treatment for refractory congestive heart failure is tailored for each patient based on:
 
  • The other diseases present
  • Previous response to heart failure treatment
  • Expectations regarding daily life.
     
A key step is attempting to treat any other disease that is causing the condition. Refractory congestive heart failure that remains after attempting to improve other diseases should be considered severe heart failure.
 

Refractory Congestive Heart Failure and Severe Symptoms

Severe refractory congestive heart failure is a progressive condition that can generally be expected to get worse and eventually lead to death.
 
It is important that you and your family discuss what you can expect and your final treatment options with your doctor while you are able to do so. The time may come when you are unable to participate in discussions about your healthcare.
 
Your doctor may also order extra oxygen if you continue to have trouble breathing. The extra oxygen can be given in the hospital and at home.
 
People with very severe refractory congestive heart failure may be considered for a:
 
  • Mechanical heart pump
  • Heart transplant.
     
A heart pump is a special device placed inside the body to help deliver blood to the rest of the body. There are different kinds of heart pumps. Some stay in the body for a short period of time, while others can stay in the body for a long time. Many people with a heart pump will also be considered for a heart transplant.
 
A heart transplant is surgery to replace the heart of a patient with heart failure with a healthy heart from someone who has recently died. A transplant is indicated in some people when all other congestive heart failure treatments fail to control the symptoms.
 
In people with refractory congestive heart failure, the costs of care, prevalence of the disease, and death rate can be reduced by:
 
  • Optimizing the treatment plan
  • Aggressively monitoring the condition
  • Providing early intervention to avert heart failure.
     
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Written by/reviewed by: Arthur Schoenstadt, MD
Last reviewed by: Arthur Schoenstadt, MD