Skip to main content
SpringerLink
Log in

End-of-life care in heart failure

  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

The clinical syndrome of heart failure is increasing in prevalence, as is the number of elderly persons with heart failure. Increasing frailty and progression of heart failure in large numbers of patients means clinicians are increasingly challenged to provide end-of-life care for heart failure patients. End-of-life care has been little studied, but management can be understood from early clinical trials of advanced heart failure. Evidence-based heart failure medications, including angiotensin-converting enzyme inhibitors and β blockers, improve symptoms in patients with advanced heart failure and depressed ejection fraction and should usually be continued in end-stage disease. Patients also should have ongoing meticulous management of fluid status to maximize quality of life. End-of-life care should be planned with the patient and family and should incorporate comprehensive symptom management, bereavement support, and spiritual support. Ongoing communication with patients and families about prognosis can ease the planning of care when the end of life nears.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Ko DT, Alter DA, Austin PC, et al.: Life expectancy after an index hospitalization for patients with heart failure: a population-based study. Am Heart J 2008, 155:324–331.

    Article  PubMed  Google Scholar 

  2. Mozaffarian D, Anker SD, Anand I, et al.: Prediction of mode of death in heart failure: the Seattle Heart Failure Model. Circulation 2007, 116:392–398.

    Article  PubMed  Google Scholar 

  3. Remme WJ, Cleland JG, Erhardt L, et al.: Effect of carvedilol and metoprolol on the mode of death in patients with heart failure. Eur J Heart Fail 2007, 9:1128–1135.

    Article  PubMed  CAS  Google Scholar 

  4. Teuteberg JJ, Lewis EF, Nohria A, et al.: Characteristics of patients who die with heart failure and a low ejection fraction in the new millennium. J Card Fail 2006, 12:47–53.

    Article  PubMed  Google Scholar 

  5. Derfler MC, Jacob M, Wolf RE, et al.: Mode of death from congestive heart failure: implications for clinical management. Am J Geriatr Cardiol 2004, 13:299–304.

    Article  PubMed  Google Scholar 

  6. Carson P, Anand I, O’Connor C, et al.: Mode of death in advanced heart failure: the Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) trial. J Am Coll Cardiol 2005, 46:2329–2334.

    Article  PubMed  Google Scholar 

  7. Kim DH, Hunt SA: Heart failure management: caregiver versus care plan. Circulation 2003, 108:129–131.

    Article  PubMed  Google Scholar 

  8. Komajda M, Hanon O, Hochadel M, et al.: Management of octogenarians hospitalized for heart failure in Euro Heart Failure Survey 1. Eur Heart J 2007, 28:1310–1318.

    Article  PubMed  Google Scholar 

  9. Yamoski LM, Hasselblad V, Moser DK, et al.: Prediction of rehospitalization and death in severe heart failure by physicians and nurses in the ESCAPE trial. J Card Fail 2007, 13:8–13.

    Article  Google Scholar 

  10. Lee DS, Austin PC, Rouleau JL, et al.: Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA 2003, 290:2581–2587.

    Article  PubMed  CAS  Google Scholar 

  11. Levy WC, Mozaffarian D, Linker DT, et al.: The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation 2006, 113:1424–1433.

    Article  PubMed  Google Scholar 

  12. Huynh BC, Rovner A, Rich MW: Identification of older patients with heart failure who may be candidates for hospice care: development of a simple four-item risk score. J Am Geriatr Soc 2008, 56:1111–1115.

    Article  PubMed  Google Scholar 

  13. Goodlin SJ, Kutner J, Connor S, et al.: Hospice care for heart failure patients. J Pain Symptom Manag 2005, 29:525–528.

    Article  Google Scholar 

  14. Hauptman PJ, Swindle J, Hussain Z, et al.: Physician attitudes toward end-stage heart failure: a national survey. Am J Med 2008, 121:127–135.

    Article  PubMed  Google Scholar 

  15. Goodlin SJ, Trupp R, Bernhardt P, et al.: Development and evaluation of the “Advanced Heart Failure Clinical Competence Survey”: a tool to assess knowledge of heart failure care and self-assessed competence. Pat Educ Couns 2007, 67:3–10.

    Article  Google Scholar 

  16. Allen LA, Yager JE, Fund MJ, et al.: Discordance between patient-predicted and model-predicted life expectancy among ambulatory patients with heart failure. JAMA 2008, 299:2533–2542.

    Article  PubMed  CAS  Google Scholar 

  17. Goodlin SJ, Hauptman PJ, Arnold R, et al.: Consensus statement: Palliative and supportive care in advanced heart failure. J Card Fail 2004, 10:200–209.

    Article  PubMed  Google Scholar 

  18. Hauptman PJ, Havranek EP: Integrating palliative care into heart failure care. Arch Intern Med 2005, 165:374–378.

    Article  PubMed  Google Scholar 

  19. Goodlin SJ, Quill TE, Arnold RM: Communication and decision-making in heart failure. J Card Fail 2008, 14:106–113.

    Article  PubMed  Google Scholar 

  20. A placebo-controlled trial of captopril in refractory chronic congestive heart failure. Captopril Multicenter Research Group [no authors listed]. J Am Coll Cardiol 1983:755–763.

  21. Packer M, Fowler MB, Roecker EB, et al.: Effect of carvedilol on the morbidity of patients with severe chronic heart failure. Circulation 2002, 106:2194–2199.

    Article  PubMed  Google Scholar 

  22. Krum H, Sackner-Bernstein JD, Goldsmith RL, et al.: Double-blind, placebo-controlled study of the long-term efficacy of carvedilol in patients with severe chronic heart failure. Circulation 1995, 92:1499–1506.

    PubMed  CAS  Google Scholar 

  23. Pitt B, Zannad F, Remme WJ, et al.: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999, 341:709–717.

    Article  PubMed  CAS  Google Scholar 

  24. Evangelista LS, Moser DK, Westlake C, et al.: Correlates of fatigue in patients with heart failure. Prog Cardiovasc Nurs 2008, 23:12–17.

    PubMed  Google Scholar 

  25. Mancini DM, Katz SD, Lang CC, et al.: Effect of erythropoietin on exercise capacity in patients with moderate to severe chronic heart failure. Circulation 2003, 107:294–299.

    Article  PubMed  CAS  Google Scholar 

  26. Colin Ramirez E, Castillo Martinez L, Orea Tejeda A, et al.: Effects of a nutritional intervention on body composition, clinical status and quality of life in patients with heart failure. Nutrition 2004, 20:890–895.

    Article  PubMed  Google Scholar 

  27. Bradley TD, Logan AG, Kimoff RJ, et al.: Continuous positive airway pressure for central sleep apnea and heart failure. CANPAP investigators. N Engl J Med 2005, 353:2025–2033.

    Article  PubMed  CAS  Google Scholar 

  28. Arzt M, Bradley TD: Treatment of sleep apnea in heart failure. Am J Respir Crit Care Med 2006, 173:1300–1308.

    Article  PubMed  Google Scholar 

  29. Weber KT: Furosemide in the long-term management of heart failure. The good, the bad and the uncertain. J Am Coll Cardiol 2004, 44:1308–1310.

    PubMed  CAS  Google Scholar 

  30. Conraads VM, Beckers P, Vaes J, et al.: Combined endurance/resistance training reduces NT-proBNP levels in patients with chronic heart failure. Eur Heart J 2004, 25:1797–1805.

    Article  PubMed  CAS  Google Scholar 

  31. Beniaminovitz A, Lang CC, LaManca J, Mancini DM: Selective low-level leg muscle training alleviates dyspnea in patients with heart failure. J Am Coll Cardiol 2002, 40:1602–1608.

    Article  PubMed  Google Scholar 

  32. Belardinelli R, Georgiou D, Cianci G, et al.: Randomized controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life and clinical outcome. Circulation 1999, 99:1173–1182.

    PubMed  CAS  Google Scholar 

  33. Johnson MJ: Morphine for the relief of breathlessness in patients with chronic heart failure Eur Heart J 2002, 4:753–756.

    Article  CAS  Google Scholar 

  34. Chua TP, Harrington D, Ponikowski P, et al.: Effects of dihydrocodeine on chemosensitivity and exercise tolerance in patients with chronic heart failure. J Am Coll Cardiol 1997, 29:147–152.

    Article  PubMed  CAS  Google Scholar 

  35. Williams SG, Wright DJ, Marshall P, et al.: Safety and potential benefits of low dose diamorphine during exercise in patients with chronic heart failure. Heart 2003, 89:1085–1086.

    Article  PubMed  CAS  Google Scholar 

  36. Weir MR: Renal effects of nonselective NSAIDs and coxibs. Cleve Clin J Med 2002, 69:SI53–SI58.

    Article  PubMed  Google Scholar 

  37. Page J, Henry D: Consumption of NSAIDs and the development of congestive heart failure in elderly patients: an under-recognized public health problem. Arch Intern Med 2000, 160:777–784.

    Article  PubMed  CAS  Google Scholar 

  38. Mamdani M, Juurlink DN, Lee DS, et al.: Cyclo-oxygenase-2 inhibitors versus non-selective non-steroidal anti-inflammatory drugs and congestive heart failure outcomes in elderly patients: a population-based cohort study. Lancet 2004, 363:1751–1756.

    Article  PubMed  CAS  Google Scholar 

  39. Hryniewicz K, Androne AS, Hudaihed A, Katz SD: Partial reversal of cachexia by beta-adrenergic receptor blocker therapy in patients with chronic heart failure. J Card Fail 2003, 9:464–468.

    Article  PubMed  CAS  Google Scholar 

  40. Anker SD, Negassa A, Coats AJ, et al.: Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting enzyme inhibitors: an observational study. Lancet 2003, 361:1077–1083.

    Article  PubMed  CAS  Google Scholar 

  41. Archana R, Gray D: The quality of life in chronic disease—heart failure is as bad as it gets. Eur Heart J 2002, 23:1806–1808.

    Article  PubMed  CAS  Google Scholar 

  42. Murray SA, Kendall M, Boyd K, et al.: Exploring the spiritual needs of people dying of lung cancer or heart failure: a prospective qualitative interview study of patients and their carers. Palliat Med 2004, 18:39–45.

    Article  PubMed  Google Scholar 

  43. Horne G, Payne S: Removing the boundaries: palliative care for patients with heart failure Palliat Med 2004, 18:291–296.

    Article  PubMed  Google Scholar 

  44. Gillian R, Pulchalski CM: Spiritual support in heart failure patients. In Supportive Care in Heart Failure. Edited by Beattie J, Goodlin SJ. New York, NY: Oxford University Press; 2008:299–318.

    Google Scholar 

  45. Puchalski C, Romer AL: Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med 2000, 3:129–137.

    Article  PubMed  CAS  Google Scholar 

  46. Sullivan M, Levy WC, Russo JE, Spertus JA: Depression and health status in patients with advanced heart failure: a prospective study in tertiary care. J Card Fail 2004, 10:390–396.

    Article  PubMed  Google Scholar 

  47. Bekelman DB, Sullivan M: Depression and anxiety in patients with chronic heart failure. In Supportive Care in Heart Failure. Edited by Beattie J, Goodlin SJ. New York, NY: Oxford University Press; 2008:273–298.

    Google Scholar 

  48. Stuart B, Alexander C, Arenella C, et al.; for Standards and Accreditation Committee, Medical Guidelines Task Force: Medical Guidelines for Determining Prognosis in Selected Non-Cancer Diseases. Arlington, VA: National Hospice Organization; 1996.

    Google Scholar 

  49. Hauptman PJ, Goodlin SJ, Lopatin M: Characteristics of patients hospitalized with acute decompensated heart failure who are referred for hospice care. Arch Intern Med 2007, 167:1990–1997.

    Article  PubMed  Google Scholar 

  50. Hershberger RE, Nauman D, Walker TL, et al.: Care processes and clinical outcomes of continuous outpatient support with inotropes (COSI) in patients with refractory endstage heart failure. J Card Fail 2003, 9:180–187.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Patient-centered Education and Research, 681 East 17th Avenue, Salt Lake City, UT, 84103, USA

    Sarah J. Goodlin

Authors
  1. Sarah J. Goodlin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah J. Goodlin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goodlin, S.J. End-of-life care in heart failure. Curr Cardiol Rep 11, 184–191 (2009). https://doi.org/10.1007/s11886-009-0027-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-009-0027-7

Keywords

Search

Navigation