Feature Article

What to expect in the end stages of heart failure

ANUPAM C.A. RAO, Andrew Sindone




Heart failure is a progressive life-limiting condition with worse five-year survival than many cancers and an uncertain trajectory in its advanced stages. Advance care planning and shared decision making for delivering palliative care are important but are often left too late or neglected. Early planning and open communication with patients and their caregivers are essential to ensuring best care for patients with end-stage heart failure.

Key Points

  • End-stage heart failure should be thought of as a terminal condition.
  • The patient’s journey is characterised by a nonlinear deterioration, with an often unpredictable clinical course and prognosis.
  • Early multidisciplinary input, including advance care directive planning and early palliative care input, is the key to effective management.
  • Many heart failure therapies also have a significant symptom control benefit and should be part of the palliation strategy, rather than being abruptly stopped, as in palliation for other illnesses.
  • When further mortality benefits can no longer be achieved, it is crucial to focus on symptom control and avoiding hospitalisation.