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Heart failure - chronic - Management
How do I recognize end-stage heart failure?

  • People can be regarded as being in end-stage heart failure if they are at high risk of dying within about 6 months. However, predicting the illness trajectory is difficult; it is much harder in severe heart failure than in cancer.
  • Liaise with a cardiologist if there is uncertainty, and to make sure all treatment options have been considered.
  • People are likely to be in end-stage heart failure if:
    • They respond poorly to treatment and are severely breathless (and if measured, the left ventricular systolic ejection fraction is less than 20%).
    • A minor decompensation or an additional illness (such as a respiratory tract infection) results in acute deterioration and increasingly frequent hospital admissions.
    • Renal impairment and low blood pressure limit the use of drug treatments.
    • They are having frequent admissions to hospital with heart failure.
  • The most distressing symptoms in end-stage heart failure are pain, breathlessness, low mood, anxiety, and urinary incontinence.
    • The most common symptoms experienced by people with heart failure in the last months of life are pain, breathlessness, and fatigue. Other common symptoms and problems include constipation, nausea, loss of appetite, oedema, anxiety, depression, sleeplessness, urinary incontinence, and faecal incontinence. Cognitive impairment may also effect some people.

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