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:
End-of-life care
End-of-life care becomes especially important when the patient no longer responds to heart failure treatments, or when they clearly express the wish not to prolong life, and even to consider active measures to shorten it.
There are several possible approaches to support this stage. The choice always depends on the specific clinical situation and the patient’s wishes.
Comfort therapy
End-of-life palliative care focuses above all on relieving, as fully as possible, the patient’s physical, psychological, and existential suffering, without seeking to hasten death. Attentive listening to the needs and wishes of the patient and their family remains the best guide for tailoring interventions.
A multidisciplinary team is available to provide support and presence to both the patient and their loved ones, according to everyone’s needs.
At this stage of the illness, all treatments deemed unnecessary for comfort are stopped. Care focuses solely on symptom relief.
Morphine is often used, in carefully adjusted small doses, to ease pain and shortness of breath without hastening death. Other medications may be prescribed to calm anxiety, agitation, or respiratory rattling, which can occur at the end of life.
Respect and dignity
These measures allow, in the vast majority of cases, to ensure the patient’s comfort and dignity until the end. The goal is to respect the natural pace of death while supporting the patient and their loved ones at every stage.
It is essential to inform the care team if any suffering—physical or psychological—persists. The patient’s well-being and the preservation of their dignity always remain the top priority.
Discontinuation of treatment
A patient may choose to stop a treatment that keeps them alive if they do not wish to prolong their life unnecessarily.
For example, a person dependent on a pacemaker or regular dialysis may request that these treatments be stopped if this has not already been decided during prior end-of-life discussions.
The same applies to the discontinuation of intravenous fluids, which provide water and nutrients.
As for oxygen therapy, it is generally considered part of comfort care; however, the patient’s decision regarding its use must also be respected.
Continuous palliative sedation
In rare cases, when a patient at the end of life continues to suffer despite well-managed palliative care, it is possible to opt for continuous palliative sedation.
The suffering may be physical, such as intense pain or severe shortness of breath, but it can also be psychological, stemming from profound anxiety about death.
Medications are then administered to place the patient into a deep sleep, relieving what is deemed unbearable suffering. This coma is maintained until death, which usually occurs within a few days.
If the patient is too confused to express this choice themselves, their loved ones may consent to this option on their behalf.
Approaching Death
The discontinuation of treatments, combined with appropriate palliative care, helps preserve the patient’s comfort and dignity in their final moments.
This phase can last from a few minutes to several days, depending on the situation. Even though the exact duration is hard to predict, care teams are trained to recognize the signs of imminent death and to ensure a constant state of well-being.
Where to Die
All of the end-of-life care described above can be provided at home, in a hospital, in a long-term care facility (nursing home), or in a specialized palliative care unit.
The place where a person spends their final moments depends on several factors:
- Their expressed preferences,
- The trajectory of the disease (predictable progression or sudden complications),
- The ability of loved ones to provide support and presence at home,
- The availability of a specialized palliative care team at home.
-In the hospital
Many patients with heart failure die in the hospital because, unlike cancer, the progression of the disease is harder to predict.
These patients often have a fragile balance that can be disrupted by a triggering factor, such as an infection, leading to a rapid deterioration of their overall condition. In such situations, the patient is hospitalized, and palliative care is initiated when their condition worsens despite treatments.
-In a palliative care center
Admission to a palliative care unit or center is also an option, depending on the course of the illness and the family situation. The patient can be transferred there from home or following a hospital stay.
In all cases, the patient’s wishes are respected as much as possible. Their preferences regarding their final moments are taken into account, and the care team does everything it can to ensure comfort in every sense of the word. At this stage, open and attentive communication with the patient and their loved ones is more important than ever.
Medical Assistance in Dying
Finally, in some countries, including Canada, a patient may now request medical assistance in dying.
Beyond the personal or religious beliefs of loved ones or healthcare providers, this process is regulated by law and is above all intended to respect the patient’s will and dignity.
Support and appropriate resources are provided to ensure that this choice is informed and carried out with humanity.
Read more: Medical Assistance in Dying
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