Current Heart Failure Reports

, Volume 13, Issue 1, pp 20–29 | Cite as

Complex Care Options for Patients With Advanced Heart Failure Approaching End of Life

  • Sara E. Wordingham
  • Colleen K. McIlvennan
  • J. Nicholas Dionne-Odom
  • Keith M. Swetz
Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (A Hasan, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise


Care for patients with advanced cardiac disease continues to evolve in a complex milieu of therapeutic options, advanced technological interventions, and efforts at improving patient-centered care and shared decision-making. Despite improvements in quality of life and survival with these interventions, optimal supportive care across the advanced illness trajectory remains diverse and heterogeneous. Herein, we outline challenges in prognostication, communication, and caregiving in advanced heart failure and review the unique needs of patients who experience frequent hospitalizations, require chronic home inotropic support, and who have implantable cardioverter-defibrillators and mechanical circulatory support in situ, to name a few.


Ventricular assist device Heart failure Mechanical circulatory support Advance care planning Caregiver Inotropes Palliative care End of life 



End of life


Quality of life


Implantable cardioverter-defibrillator


Left ventricular assist device


Heart failure


Destination therapy


Mechanical circulatory support


Centers for Medicare & Medicaid Services


Compliance with Ethical Standards

Conflict of Interest

Sara E. Wordingham and Colleen K. McIlvennan declare that they have no conflict of interest.

J. Nicholas Dionne-Odom is a postdoctoral fellow supported by a National Palliative Care Research Center Career Development Award.

Keith M. Swetz has received salary support from the US Federal Government (Department of Veterans Affairs; Birmingham Veterans Affairs Medical Center).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sara E. Wordingham
    • 1
  • Colleen K. McIlvennan
    • 2
  • J. Nicholas Dionne-Odom
    • 3
  • Keith M. Swetz
    • 4
  1. 1.Department of Medicine, Division of Hematology/Oncology, Palliative MedicineMayo ClinicPhoenixUSA
  2. 2.Section of Advanced Heart Failure and Transplantation, Division of CardiologyUniversity of Colorado School of Medicine, Aurora and Colorado Cardiovascular Outcomes Research ConsortiumDenverUSA
  3. 3.School of NursingUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center; Birmingham VA Medical Center; and Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamUSA

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