What should you know about last days of congestive heart failure?

The heart may circulate less blood, while fluid can build up in the lungs or tissues. A person may become very tired, sleep more, feel breathless, have a cough, or develop swollen ankles. Appetite and thirst can lessen, and attention may vary. These changes can also occur during a flare that is treatable, so the clinical team should assess what is happening rather than assume the cause.

Care can include reviewing medicines, positioning the upper body, easing breathlessness, managing troublesome fluid, and supporting emotional and spiritual needs. A chronic disease review can help clarify goals and practical support.

Contact the heart-failure or palliative-care team promptly if symptoms are worsening, medicines are difficult to take, or the person is distressed. Keep prescribed medicines available, offer small sips if safe, and use pillows or an upright position for breathing comfort. Do not add, stop or double medicines without clinical advice. Include the person in decisions when possible and ask who to call at any hour.

Call emergency services for severe breathing difficulty, blue or grey lips, new collapse, chest pressure, sudden confusion, or inability to wake the person. If breathlessness is increasing but not immediately severe, contact the treating team the same day. A cough, fatigue, palpitations or swollen ankles should be reported when new or clearly worse.

Ask what changes are expected, which symptoms need urgent help, how medicines should be used, and whether home nursing or palliative support is available. Clarify the preferred emergency contact and the person’s documented care wishes.