Reading the words “palliative care” can have a strong impact and may even cause concern. However, it’s important not to misunderstand their meaning. Like any severe chronic illness, heart failure involves two types of treatment. The first is well known: so-called “active” care, focused on controlling the disease, stabilizing its progression, and improving quality of life. The second, often less well understood, involves palliative care, which aims to enhance patient comfort and well-being.
Five Key Areas
This article explores five essential aspects of care for people living with advanced heart failure:
- A review of heart failure and active treatment
- Development of a personalized action plan
- Supportive care in addition to active treatment
- Imminente end-of-life stage
- End-of-life care
The Heart: Engine of Circulation
The heart is a muscular pump that ensures continuous bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow throughout the body, delivering oxygen and nutrients to cells and removing metabolic waste.
When the Pump Falters
If this pump becomes less efficient, waste products build up in the body. This may disrupt organ function—including the kidneys and liver—lead to increased fatigue, and cause mental slowing, such as decreased concentration.
Read more: Understanding Heart Failure
The Effects of Advanced Heart Failure
In advanced stages—and especially near end of life—patients often experience profound exhaustion, shortness of breath even at rest or during sleep, depressive mood, discouragement, and lack of motivation.
Quality of life may substantially decline, sometimes more significantly than in patients with advanced cancer.
Standard Treatment Phase: Active Therapy
Active care includes all treatments aimed at daily quality of life improvements and extending life expectancy. This treatment phase is essential in managing heart failure.
Two Complementary Pillars
Active therapy is based on two inseparable components: medications and non-pharmacological measures.
Medication Treatments
This is the foundation of heart failure management. The prescribed pills must be taken regularly, as directed by the physician. The classes of medications commonly used include:
- Angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers (ARBs), or sacubitril/valsartan (Entresto),
- sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors),
- beta-blockers,
- diuretics,
- and sometimes ivabradine.
See the “Pharmacy” section for more information about these therapies.
Non-Pharmacological Measures
These lifestyle adaptations are equally crucial and typically include:
- fluid restriction (1.5–2 L/day),
- a low-sodium diet,
- daily weight monitoring,
- vaccination against flu and pneumonia,
- and bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure control.
Certain conditions also require attention:
- presence of anemia,
- reduced kidney function,
- thyroid imbalance (hyperthyroidism),
- cardiac rhythm disturbances,
- and significant drops in bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure.
In some cases, a biventricular pacemaker (Bi-V) may be recommended to improve heart function.
Read more: Biventricular pacemaker (Bi-V)
Quality of Life Means Different Things to Different People
Quality of life varies between individuals and shifts over time as capacities change. Patients often adapt to their limitations and redefine priorities, often saying things like, “I don’t do that anymore, I leave it to others,” or “I can’t do that any longer.”
A multidisciplinary approach, provided by a team of professionals with complementary expertise, gives patients the tools they need to maintain — and sometimes improve — their quality of life.
Heart failure clinics (CLICs) are valuable resources, especially for physicians less familiar with this condition. They offer thorough follow-up care, which is particularly helpful in more complex cases.
Read more: Heart Failure Clinic (CLIC)
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