Site Map

Heart failure - palliative care

CHF - 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.

You may have already discussed heart transplantation and the use of a ventricular assist device with your doctor.

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.

Advance care directives are documents that state the type of care you would like to have if you are unable to speak for yourself.

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:

Using oxygen will help you combat shortness of breath and keep a person with end-stage heart failure comfortable. Safety measures (such as not smoking) are very important when using oxygen at home.

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.

Talk to your provider about things you can do to help manage nausea or vomiting and constipation.

Other Symptoms

Anxiety, fear, and sadness are common among people with end-stage heart failure.

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.

Some people may have problems with bladder control or bowel function. Talk with your provider before using any medicines, laxatives, or suppositories for these symptoms.

References

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.

Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol. 2023;81(15):1551. PMID: 35379503 pubmed.ncbi.nlm.nih.gov/35379503/.

Mann DL. Management of heart failure patients with reduced ejection fraction. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 50.

BACK TO TOP

Review Date: 4/10/2023  

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 C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

ADAM Quality Logo
Health Content Provider
06/01/2025

A.D.A.M., Inc. is accredited by URAC, for Health Content Provider (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics. This site complied with the HONcode standard for trustworthy health information from 1995 to 2022, after which HON (Health On the Net, a not-for-profit organization that promoted transparent and reliable health information online) was discontinued.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2024 A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.