End-stage heart failure is marked by deterioration of the physical heart and symptoms that persist in spite of treatment. The New York Heart Association (NYHA) system of symptom classification describes Class IV, or end-stage, heart failure as a condition in which a patient shows the typical symptoms of heart failure — such as fatigue and shortness of breath — "at rest, and any physical activity only increases the discomfort."
End-stage patients may suffer serious damage to other organs due to lack of adequate blood flow. They may be at high risk of imminent death, and at a critical point, end-stage patients need some kind of support to survive. Such patients may be hospitalized awaiting a heart transplant, at home receiving continuous intravenous support, or supported by a mechanical assist device.