Heart failure - palliative careCHF - palliative; Congestive heart failure - palliative; Cardiomyopathy - palliative; HF - palliative; Cardiac cachexia; End-of-life-heart failure
It is important to talk to your health care providers and your family about the kind of end-of-life care you want when you are being treated for heart failure.
Making Some Decisions
Chronic heart failure very often gets worse over time. Many people who have heart failure die of the condition. It can be hard to think and talk about the type of care you want at the end of your life. However, discussing these subjects with your doctors and loved ones may help bring you peace of mind.
A heart transplant is surgery to remove a damaged or diseased heart and replace it with a healthy donor heart.
Ventricular assist device
Ventricular assist devices (VADs) help your heart pump blood from one of the main pumping chambers to the rest of your body or to the other side of t...
At some point, you will be faced with the decision about whether to continue active or aggressive treatment of heart failure. Then, you may want to discuss the option of palliative or comfort care with your providers and loved ones.
Many people wish to stay in their homes during the end of life period. This is often possible with the support of loved ones, caregivers, and a hospice program. You may need to make changes in your home to make life easier and keep you safe. Hospice units in hospitals and other nursing facilities are also an option.
Keep you safe
Ear emergencies include objects in the ear canal, ruptured eardrums, and severe infections.
Advance care directives are documents that state the type of care you would like to have if you are unable to speak for yourself.
Advance care directives
When you are very ill or injured, you may not be able to make health care choices for yourself. If you are unable to speak for yourself, your health...
Fatigue and Breathlessness
Fatigue and breathlessness are common problems at the end of life. These symptoms can be distressing.
You may feel short of breath and have trouble breathing. Other symptoms may include tightness in the chest, feeling as if you are not getting enough air, or even feeling like you're being smothered.
Family or caregivers can help by:
- Encouraging the person to sit upright
- Increasing the airflow in a room by using a fan or opening a window
- Helping the person relax and not panic
Because of your sickness, you may need to use oxygen to help you breathe. You will need to know how to use and store your oxygen.
Oxygen makes things burn much faster. Think of what happens when you blow into a fire; it makes the flame bigger. If you are using oxygen in your h...
Morphine can also help shortness of breath. It is available as a pill, liquid, or tablet that dissolves under the tongue. Your provider will tell you how to take morphine.
Eating and Digestive Symptoms
Symptoms of fatigue, shortness of breath, loss of appetite, and nausea can make it hard for people with heart failure to take in enough calories and nutrients. Wasting of muscles and weight loss are part of the natural disease process.
It can help to eat several small meals. Choosing foods that are appealing and easy to digest can make it easier to eat.
Caregivers should not try to force a person with heart failure to eat. This does not help the person live longer and may be uncomfortable.
Nausea or vomiting
Having nausea (being sick to your stomach) and vomiting (throwing up) can be very difficult to go through. Use the information below to help you mana...
Constipation is when you do not pass stool as often as you normally do. Your stool becomes hard and dry, and it is difficult to pass.
Anxiety, fear, and sadness are common among people with end-stage heart failure.
- Family and caregivers should look for signs of these problems. Asking the person about his or her feelings and fears can make it easier to discuss them.
- Morphine can also help with fearfulness and anxiety. Certain antidepressants may also be useful.
Pain is a common problem in the end stages of many diseases, including heart failure. Morphine and other pain medicines can help. Common over-the-counter pain medicines, such as ibuprofen, are often not safe for people with heart failure.
You have urinary incontinence. This means you are not able to prevent urine from leaking from your urethra. This is the tube that carries urine out...
Health conditions that cause nerve damage can cause problems with how your bowels function. A daily bowel care program can help manage this problem ...
Allen LA, Matlock DD. Decision making and palliative care in advanced heart failure. In: Felker GM, Mann DL, eds. Heart Failure: A Companion to Braunwald's Heart Disease. 4th ed. Philadelphia, PA: Elsevier, 2020:chap 50.
Allen LA, Stevenson LW. Management of patients with cardiovascular disease approaching end of life.. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier Saunders; 2019:chap 31.
Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128(16):e240-e327. PMID: 23741058 www.ncbi.nlm.nih.gov/pubmed/23741058.
Review Date: 4/14/2019
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.