Management of end-stage heart failure

The prevalence of heart failure (HF) is increasing and morbidity and mortality remain high. There is a clear need for palliative care for the growing population of chronically ill patients with HF. Because HF-specific therapy modifies disease and palliates symptoms, recommended treatments for chronic and acute decompensated HF are reviewed. This article discusses symptom burden in advanced HF and specific considerations for patients with HF regarding advance care planning and symptom-directed therapy. Options for care at the end of life, including hospice, chronic inotropic support, and deactivation of an internal cardiac defibrillator, are also discussed.