End of life and heart failure

Heart failure can become harder to control, with breathlessness, fatigue, cough, poor appetite, sleep disruption or swelling in the legs and ankles. Symptoms can fluctuate, and a change does not by itself show exactly how much time remains. The care team can explain the person’s current condition and uncertainty in clear language.

Palliative care can be introduced alongside heart treatment. It addresses breathlessness, pain, anxiety, nausea, practical needs and emotional or spiritual concerns. It is also appropriate to discuss where care should take place and who should be contacted day or night.

Ask for a coordinated review of medicines, fluid advice, equipment, mobility and home support. Record the person’s preferences about hospital visits, emergency treatment, resuscitation discussions and who may speak for them if they cannot communicate. Plans can be revisited as needs change.

Use prescribed medicines as directed and report symptoms that are troublesome or new. A calm environment, an upright position and help with essential activities may ease distress, but changes to medicines or fluids should be agreed with the care team.

Call emergency services for severe breathlessness at rest, collapse, new confusion, blue lips, severe chest pain or a sudden major change. If the person has an agreed urgent-care plan, follow it and contact the named team. Ask for prompt clinical advice when symptoms are worsening, medicines cannot be taken, or the family is struggling to manage at home.

Ask what changes are expected, which symptoms can be treated at home, whom to call outside appointments, whether palliative care is involved, and how the person’s wishes will be recorded and shared.