Advanced heart failure and transplant cardiology

Advanced heart failure means the heart is struggling to meet the body's needs and symptoms continue or return despite standard care. Heart failure commonly presents with breathlessness, fatigue, reduced exercise capacity, cough, or swollen ankles. The specialist team reviews the diagnosis, heart rhythm, blood pressure, kidney and liver function, current medicines, previous procedures, daily functioning, nutrition, and available support at home.

Referral does not automatically mean a transplant. Options may include adjusting medicines, a rhythm or pacing device, treatment of a contributing heart problem, a ventricular assist device that helps the heart pump, transplant assessment, rehabilitation, or palliative care alongside active treatment. Suitability depends on the whole clinical picture and the person's priorities.

Take medicines exactly as prescribed and do not stop a heart medicine because you feel better or notice a possible side effect; contact the treating team for specific advice. Bring an up-to-date medicine list, discharge letters, device information, and a record of recent symptoms to appointments. Tracking morning weight, ankle swelling, breathing, blood pressure if requested, and ability to complete usual activities can reveal change early.

Follow the team's personalised advice about salt, fluids, activity, vaccinations, travel, and what to do when unwell. A family member or trusted supporter can attend major discussions. Keep the heart failure service's contact details accessible and use the agreed plan when symptoms begin to worsen.

Seek emergency help for severe breathlessness at rest, fainting, new confusion, blue or grey lips, or chest pressure that is intense, persistent, or accompanied by sweating or nausea. Contact the heart failure team promptly for rapidly increasing swelling, a noticeable sudden weight rise, needing more pillows to breathe, waking gasping, much less urine, worsening palpitations, or symptoms that prevent basic daily tasks.

Ask what is driving the heart failure, whether current treatment is fully optimised, which specialist options fit your health, and what each option aims to improve. Clarify which tests are needed, how other organs affect eligibility, who to contact after hours, and whether advance care planning should be discussed alongside treatment decisions.