Palliative Care in End-Stage Heart Failure

Heart failure (HF) is the most common cause of death. The acute syndrome of HF, better known as congestive heart failure, accounts for at least 20% of medical admissions to all hospitals for patients older than age 65 years. HF tends to have a high symptom burden (dyspnea, fatigue, edema, pain, nausea, anxiety, and depression) and periods of decompensation often requiring hospitalization. There is a high level of prognostic uncertainty, leading to significant psychosocial distress for both patients and their caregivers. Advance care planning and complex shared decision-making become increasingly important as HF progresses, particularly when patients are faced with options such as transplant and mechanical circulatory support, which may not align well with their overall goals or preferences. This chapter discusses the key issues related to end-stage HF, including diagnosis, symptom management, and prognosis.