Multidisciplinary care and advanced therapeutics in end-stage heart failure: A case report

The patient was a 72-year-old woman diagnosed with dilated-phase hypertrophic cardiomyopathy at age 60 years. At the age of 67 years, the patient began to experience recurrent heart failure (HF) that required frequent hospital admissions, and at the age of 71 years, home-based dobutamine (DOB) infusions were initiated, which reduced the number of HF-related hospitalizations. Two months prior to the patient's death, she was admitted for a compression fracture of the lumbar spine and congestive HF. Despite continued DOB (3 μg/mL/min) infusions, her health deteriorated progressively because of back pain and worsening HF. The fentanyl patch was ineffective in treating the pain, prompting the initiation of a subcutaneous morphine injections, which provided significant relief. The patient's condition improved, and she was discharged 3 days after the discontinuation of morphine; however, she was readmitted 2 days later with symptoms related to low cardiac output. As subcutaneous morphine induced nausea as a side effect, a combination of morphine and haloperidol was administered. This approach effectively alleviated her distress, allowing her to maintain oral intake until the day before she died, 20 days after readmission.

End-stage heart failure (HF) is often complicated with symptoms such as dyspnea, fatigue, pain, and nausea, which can worsen the quality of life. In our patient with end-stage HF, home-based dobutamine infusions reduced the number of hospitalizations. Furthermore, several types of continuous tranquilizers relieved her symptoms. A multidisciplinary approach with treatment strategies tailored to a patient's specific case may improve the quality of life of patients in palliative care for end-stage HF.