Chronic Heart Failure: Palliative Care Options
Chronic heart failure is a condition in which the heart struggles to pump blood as well as it used to. A person tires more quickly, has difficulty tolerating even simple exercise, experiences shortness of breath at night, develops swelling, and loses appetite.
This is also stressful for the family. The patient's condition and mood often fluctuate: one day everything is more or less normal, but the next, they are short of breath and unable to even get out of bed. Relatives are forced to devote all their free time to the patient, putting their personal lives on hold.
Palliative care does not replace primary treatment. A cardiologist continues to provide the same treatment. Palliative care physicians manage symptoms and improve the patient's quality of life.
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The role of palliative care in heart failure
Palliative care for CHF is an opportunity to live a normal life. The team's goal is to do everything possible to ensure the person can breathe, sleep, eat, talk calmly, and not live in fear. The palliative care team provides a specific action plan: what to do if symptoms worsen, how to respond if shortness of breath occurs, how to control swelling, and when to seek hospitalization.
Relief of physical symptoms (shortness of breath, pain, swelling)
Shortness of breath in heart failure is the most severe symptom. Properly selected diuretics, treatment adjustments by a cardiologist, and oxygen therapy can help. In some situations, NIVL—non-invasive ventilation via a mask—is used: it reduces asthma attacks and helps patients survive episodes of decompensation.
Edema syndrome is controlled not only by diuretics: salt intake and weight must be monitored.
Pain must be treated immediately; it cannot be tolerated. Palliative care for CHF is primarily about selecting the right doses and regimens. Another goal of palliative care is to reduce the burden on the heart and kidneys, so medications are selected based on the benefit-to-harm ratio. All of this directly impacts the patient's quality of life.
Psychological and social support for relatives
Late-onset chronic heart failure isn't just about the body. It's about anxiety, sleepless nights, and burnout for loved ones. The patient and family's psycho-emotional state often worsens due to the constant anticipation of an attack.
How to cope with fear and anxiety?
Fear increases shortness of breath: a person begins to breathe more rapidly, and panic interferes with calming down. Simple steps can help:
- Raise the patient's position (use a special bed or raise the pillow).
- Open a window and ventilate the room.
- Check oxygen saturation.
- Give the patient the medications prescribed by the doctor to relieve these symptoms.
Contact a psychologist. They will tell you how to deal with panic and explain how to control the fear of suffocation.
Teaching Relatives Care Skills
Caring for CHF is fairly simple. Relatives should administer prescribed medications and keep a symptom diary:
- Record the patient's blood pressure and weight
- Monitor pain symptoms
- Monitor swelling
- If possible, record the patient's daily meals (this can help identify foods that increase swelling)
Palliative care for CHF is an opportunity to ensure a normal quality of life for the patient and their family. It reduces the number of errors and improves symptom control.
Organizing Life for a Patient with Limited Mobility
A person with limited mobility needs a bed with a raised headboard, a nightlight, and handrails for moving around the apartment. If possible, provide a toilet in the patient's room. This is especially important if you cannot be with them 24/7.
For cardiac cachexia, nutritional support is important: therapeutic nutrition in small portions to maintain strength and muscle mass.
Sometimes a social worker is involved. They help with equipment, benefits, and care arrangements.
Hospitalization is recommended if:
- Shortness of breath due to heart failure has increased
- Symptoms interfere with sleep
- Swelling develops, despite diet and medications
- Weakness has developed, preventing the person from walking
It's easier to quickly adjust treatment there. If necessary, doctors will connect the patient to NIV or oxygen therapy. Inpatient care includes 24-hour monitoring. This means family members can reclaim their lives: sleep, work, and rest. This is especially important when end-stage CHF occurs and home becomes unsafe.
Chart: Usual care vs. palliative care
| Criteria | Usual care | Palliative approach |
|---|---|---|
| Goal | Life extension | Comfort and quality of life |
| Focus of attention | Tests and numbers | Well-being, breathing, sleep |
| Family involvement | Often "intuitive" | Team Training and Support |
Important. Any changes to your medication regimen (especially diuretics and glycosides) must be discussed with your doctor. Palliative care does not replace emergency care during an acute attack. If you experience sudden shortness of breath, chest pain, or severe weakness, call an ambulance.
Conclusion: Life without pain and fear is possible
Chronic heart failure is a serious condition, but it doesn't have to turn life into endless suffering. Palliative care for CHF helps manage symptoms, reduce anxiety, maintain nutrition and strength, and preserve dignity and the warmth of relationships.
We don't add days to life; we add life to the days remaining by providing professional symptom management and human warmth.
Frequently Asked Questions
Does palliative care mean treatment is complete?
What are signs of decompensation?
Can I change the diuretic dosage myself?
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What is important to know about CHF in the late stages?
In the later stages, chronic heart failure is often associated with cardiomyopathy or previous myocardial damage. Ejection fraction decreases, and a tendency toward decompensation develops: that is, the condition can rapidly worsen due to infection, fluid overload, or medication errors.
Symptoms of heart failure become more pronounced:
End-stage CHF is a period when the body is working at full capacity. Its resources are practically depleted. At this stage, treatment and test results are not the primary concerns. Patient comfort and their family's quality of life are our top priorities.