June 3, 2008 — Many people with heart failure may be overly optimistic when it comes to estimating how long they have left to live.
A new study shows nearly two-thirds of people with congestive heart failure overestimate their remaining life expectancy by an average of 40% compared with what’s realistic based on their prognosis.
Heart failure, which occurs when the heart is too weak to pump enough blood to meet the body’s needs, causes 55,000 deaths each year and indirectly contributes to 230,000 more deaths annually in the U.S.
Although there have been recent improvements in congestive heart failure treatment, researchers say the prognosis for people with the disease is still bleak, with about 50% having an average life expectancy of less than five years. For those with advanced forms of heart failure, nearly 90% die within one year.
“Patient perception of prognosis is important because it fundamentally influences medical decision making regarding medications, devices, transplantation, and end-of-life care,” write researcher Larry A. Allen, MD, MHS, of the Duke Clinical Research Institute and colleagues in The Journal of the American Medical Association.
- End-of-Life Signs: Congestive Heart Failure
- End-stage heart failure: what to expect.
- Tips for managing congestive heart failure end-of-life signs.
- What you can do for your loved one.
- Learn more about hospice eligibility for end-stage CHF.
- End-of-Life signs by disease.
- More end-of-life resources.
- Hospice for Heart Disease & CHF (Congestive Heart Failure)
- What Can Hospice Do for the Family of a Person with Heart Disease?
- What are the Overall Benefits of Hospice Care?
- How can I Approach a Hospice Discussion with Family Members and Loved Ones?
- Request a Hospice Evaluation
- The Stages of Congestive Heart Failure
- Causes of CHF
- Management of CHF
- Early Attention to Heart Disease
- Wound Care Solutions
- What is Congestive Heart Failure (CHF)?
- How the heart works
- What causes CHF?
- What are the symptoms of CHF?
- Facts about CHF you need to know
- Heart Failure: Understanding Heart Failure: Management and Treatment
- Even for Advanced HF, there are treatment options
- What is advanced heart failure?
- What is shared decision-making?
- A (Scary) Blessing in Disguise
- The Life-Saving Procedure
- Taking Her Life Lessons to Heart
- Living with Heart Failure
- Heart Failure: Knowledge for Effective Self-Care
- Heart Failure Medications
- Lifestyle Changes
- Heart Failure Devices
- End Stages of Heart Failure: What to Expect
- What Do Symptoms of End Stage Congestive Heart Failure Look Like?
- Hospice and Congestive Heart Failure
End-of-Life Signs: Congestive Heart Failure
Nearly 6 million Americans suffer from Congestive Heart Failure. Congestive Heart Failure (CHF) occurs when the heart is unable to pump blood fast enough, resulting in swelling, shortness of breath, and other issues. There is no cure for congestive heart failure. As end-stage CHF approaches, it’s important to understand the end-of-life signs for congestive heart failure, and how hospice can help in managing these symptoms.
End-stage heart failure: what to expect.
While not all the end-of-life signs may be present in the final days of Congestive Heart Failure, below is a general outline of what a CHF patient and their loved ones can expect.
- Shortness of Breath (Dyspnea): While shortness of breath is common throughout CHF (particularly while active) it becomes much more persistent towards the end-of-life. Patients start to experience dyspnea while resting as well.
- Swelling (Edema): Because of the heart’s inability to pump blood effectively, fluid builds up in the body and swelling occurs. This swelling occurs most frequently in the legs and abdomen.
- Chronic Cough & Wheezing: Just like with the shortness of breath, a chronic cough becomes more prominent in the final months and weeks of congestive heart failure. The cough is often times accompanied by some wheezing and white or pink-colored mucus.
- Confusion & Delirium: As with any chronic, life-threatening illness, some confusion and delirium can be expected. CHF patients often times experience disorientation due to changing sodium levels in the blood.
- Rapid Heart Rate: Because the heart needs to work harder to pump blood, it will start beating significantly faster.
- No Appetite: A lack of appetite is common for patients experiencing the end-stage of a chronic illness. While not eating may be concerning to loved ones, this is a natural part of the end-of-life process.
Tips for managing congestive heart failure end-of-life signs.
You may be asking, “How can I provide comfort to my loved one as they experience the end-of-life signs of congestive heart failure?” It’s only natural that you as a caregiver will want to be as helpful as possible, and ensure that your loved one is experiencing as little pain as possible. Here’s some ways you can help:
- Communicate with the doctors and healthcare professionals: Your loved one may be too weak, or simply forget, to communicate their symptoms to the doctors and nurses. You can help by sharing this information with them in order to make sure your loved one gets what they need.
- Provide comfort: Sometimes it is just as simple as spending time with your loved one watching a TV show, or talking about things they love. These conversations can help in alleviating some of their depression and anxiety.
- Help them remember to take their medicine: There will likely be various pills and medications that your loved one needs to take. You can help by assisting your loved one in staying on schedule.
What you can do for your loved one.
In addition to symptom management, it’s important for the family caregiver to learn how to recognize the end-of-life signs for CHF, and when they should contact hospice. Hospice care will be able to address the specific needs of CHF patients in their final days, and help them to get the most out of what time they have left.
Learn more about hospice eligibility for end-stage CHF.
If you would like to learn more about hospice care and CHF, take a look at the hospice eligibility requirements for congestive heart failure. You can also get more information by contacting us via the blue Help Center bar above.
End-of-Life signs by disease.
Learn about the specific end-of-life signs of common diseases and illnesses:
- Lung Cancer
- Kidney Failure
- Pancreatic Cancer
More end-of-life resources.
- Preparing for the Death of a Parent
- Blood Pressure Before Death
- Breathing Patterns Before Death
- What is Active Dying?
- Mottled Skin Before Death
Hospice for Heart Disease & CHF (Congestive Heart Failure)
What Can Hospice Do for the Family of a Person with Heart Disease?
Family members may have to make difficult healthcare and financial decisions, act as caregivers and provide emotional support to others. If the decision is made to stop medical support, some families experience strong emotions and feel overwhelmed.
Hospice offers comprehensive services for families of patients with heart disease:
- Caregiver education and training – The family caregiver is vital in helping hospice professionals care for the patient. As the patient gets weaker, symptoms increase and communication becomes more difficult. We relieve families’ concerns by educating them on how best to care for their loved one and provide coping skills.
- Help with difficult decisions – Hospice helps families make tough choices that impact the patient’s condition and quality of life—for example, whether to give antibiotics for a recurring infection.
- A VITAS nurse by phone 24/7 – Even the most experienced caregivers will have questions and concerns. With Telecare®, they don’t have to wonder, worry or wait for an answer. After hours, Telecare provides trained hospice clinicians around the clock to answer questions or dispatch a member of the team to the bedside, if necessary.
- Emotional and spiritual assistance – Hospice meets the needs of patients and their family caregivers.
- Financial assistance – Although hospice services are covered by Medicare, Medicaid/Medi-Cal and private insurers, families may have other financial concerns that arise from a loved one’s extensive illness. Social workers can assist families with financial planning and financial assistance during hospice care. After a death, they can help grieving families find additional financial assistance through human service agencies, if needed.
- Respite care – Caring for a loved one with an end-stage illness can cause tremendous stress. Hospice offers up to five days of inpatient care for the patient in a Medicare-certified facility in order to give the caregiver a break.
- Bereavement services – The hospice team works with surviving loved ones for up to 13 months after a death to help them express and cope with their grief in their own way.
What are the Overall Benefits of Hospice Care?
If you or a loved one is facing a life-limiting illness, you may have heard the term hospice. Friends or family might have told you about the specialized medical care for patients or the support services for loved ones. But most people are unaware of the many other benefits of hospice.
Comfort. Hospice works with patients and families, providing them the support and resources to assist them through this challenging chapter of life and to helping the patient remain in comfortable and familiar surroundings.
Personal attention. Working with a patient and/or family, the hospice team members become participants in the end-of-life process, a very personal experience for any individual. The hospice mission is to care for each person individually. We listen to patients and loved ones. We advocate for them. We work to improve their quality of life.
Reduced rehospitalization. In the last months of life, some people who are seriously ill make frequent trips to the emergency room; others endure repeated hospitalizations. Hospice care reduces rehospitalization: a study of terminally ill residents in nursing homes shows that residents enrolled in hospice are much less likely to be hospitalized in the final 30 days of life than those not enrolled in hospice (24% vs. 44%).2
Security. One of the greatest benefits of hospice is the security that comes from knowing that medical support is available whenever you need it. The VITAS Telecare program assures healthcare support around the clock. And VITAS gives families the training, resources and support they need to give their ailing loved ones the care they deserve.
2Miller SC, Gozalo P, Mor V. Hospice enrollment and hospitalization of dying nursing home patients. American Journal of Medicine 2001;111(1):38-44
How can I Approach a Hospice Discussion with Family Members and Loved Ones?
The final months of life are frequently marked by strong emotions and hard decisions. Talking about hospice, even with those closest to you, can be difficult. Here are some tips to get the discussion started.
For patients speaking to families
Education is key. Educate yourself first. By now, you’ve probably done some research online. It may be helpful to read and share “Considering Hospice: A Discussion Guide for Families” at HospiceCanHelp.com. This discussion guide is a tool for you to print out and use in a family discussion.
Determine what your family members know. Before bringing up hospice, make sure your family members and caregivers have a clear understanding of your health status. People handle difficult information in different ways. If family members do not accept or understand your prognosis, ask your physician, clergy, a VITAS social worker or a trusted friend to speak with them on your behalf.
Discuss your goals for the future, as well as theirs. As a patient, your greatest concern might be to live without pain, to stay at home or not to be a burden. Ask your family members/caregivers about their concerns as they consider the coming days, weeks and months. Explain that hospice is not giving up. It is an active choice to ensure that everyone’s needs are met.
Take initiative. Remember, it’s up to you to express your wishes. Sometimes, out of concern for your feelings, your family or loved ones might be reluctant to raise the issue of hospice care for you.conversation
For families speaking to patients
Education. You’ve probably done some research online. It might also be helpful for you to read and share “Considering Hospice: A Discussion Guide for Families” at HospiceCanHelp.com. This discussion guide is a tool for you to print out and use in a family conversation.
Ask permission. Asking permission to discuss a difficult topic assures your ill family member that you will respect and honor his or her wishes. Say something like, “I would like to talk about how we can continue to ensure you get the very best care and attention as your condition progresses. Is that okay?”
Determine what is important to your seriously ill family member. Ask questions about the future: “What are you hoping for in the coming months, weeks or days? What are you most concerned about?” The patient might express a desire to be comfortable, to stay at home or to not become a burden.
Discuss hospice care as a means of fulfilling the patient’s wishes. Once the patient and family are clear about what is important to the patient, explain that hospice is a way of making sure wishes and desires are met. For some, the word hospice evokes a false notion of giving up. Explain that hospice is not about surrendering to disease or death. It is about bringing quality of life to the patient’s remaining months, weeks or days.
Assure the patient that he/she is in control. Hospice gives patients options: the option to remain in the comfort of their own home, the option to take advantage of as much emotional and spiritual support as they desire, the option to have their own doctor actively involved in their care. Reassure your seriously ill family member that you will honor his or her right to make choices about what is most important in life.
Be a good listener. Keep in mind that this topic requires a conversation, not a debate. Hear what the other person is saying. Know that it is normal to encounter resistance the first time you talk about hospice care. But if you listen and understand your loved one’s barriers and reasons for resisting, you will be prepared to address and ease his/her concerns in your next hospice discussion.
Request a Hospice Evaluation
The primary physician may recommend hospice when the time is right. But as anyone who has faced a serious illness knows, patients and family members often must act as their own advocates to receive the care they need and deserve.
You, your loved one or your trusted physician may request an evaluation to see if hospice is an appropriate option for care.
The moment of death is as individual as the decades of life, yet in more and more cases doctors can answer Foley’s patient. Some of what they know comes straight out of medical textbooks. When the kidneys fail, impurities such as potassium build up in the blood, often producing cardiac arrhythmias; the chaotically beating heart stops supplying blood to the brain and the brain shuts down, one region at a time, like the floors of an office building going dark. And some of what physicians know, especially about the subjective experience of dying, comes from people who have been wrested back from death. Dr. Sherwin Nuland, author of the 1994 best seller “”How We Die,” tells the story of a patient who had a heart attack while playing tennis. The man felt darkness closing in on him, in slow motion. Neurologists know why: as the brain runs out of oxygen, it closes down noncritical functions first. Sight, hearing and consciousness fade out, as though by the gradual twist of a dimmer switch. Pain vanishes.
In some ways, the many ways to die bring different last moments. Scarlet fever produces delirium and fevers. Meningitis brings unbearable headaches and convulsions. People who bleed to death first hyperventilate: the body automatically tries to make up for the plummeting volume of blood by short, fast breaths, as if that will bring it more oxygen. Heart rate surges. But, short of blood and hence oxygen, the heart and then brain slow. A flood of natural opiates called endorphins washes over the brain, bringing on both tranquillity and hallucinations, says Nuland. These are the “”near-death experiences,” the visions of light and sense of floating, reported by people wrested back from death.
But in the end, the very end, no matter what official cause of death is printed on the death certificate, a person dies because too little oxygen reached his brain. This fact is reflected in the legal definition of death, the permanent cessation of brain function. The disease differs but the dying is the same. Some examples:
Heart disease: Blood contains the protein hemoglobin, a little ferry of a chemical whose sole cargo is an oxygen molecule. Hemoglobin picks up oxygen at the lungs, carrying it first to the left side of the heart and then out the aorta to the rest of the body. When fatty deposits narrow the arteries, too little blood reaches the heart, depriving its cells of oxygen. A crushing pain squeezes the chest, radiating down the left arm. In more than half of all people with heart disease, death follows within an hour of an attack, as the heart stops pumping blood, and hence oxygen, to the brain. But chronic congestive heart failure brings a slower, more painful death. When the weakened heart cannot pump out all the blood inside it, the blood backs up into veins and leaks through small blood vessels; tissues swell painfully. The heart beats faster; the patient huffs and puffs in a futile attempt to get oxygen; the kidneys and liver fail. And, starved of oxygen, so does the brain.
Liver failure: Stricken by cancer or hepatitis, the liver can no longer clear toxic chemicals from the body. A poisonous metabolite of ammonia builds up in the blood, explains Dr. Robert Glick, chief of emergency services at Oroville Hospital in California. When the toxic compound reaches the brain, it kills neurons in the brain stem, which controls heartbeat and respiration. The patient lapses into a coma. Consciousness fades away. There is neither pain nor other sensation. Death follows, usually within hours.
Cancer: “”Very few people die of the primary tumor”–the cancer they are said to “”have,” explains cancer surgeon Dr. Murray Brennan of Sloan-Kettering. It is metastasis that kills. If cancer cells invade the lungs, they can induce fatal pneumonia, as the lungs can no longer absorb oxygen from inhaled air. A common cause of death in cancer patients is cachexia, the weakness and wasting that make the disease so horrific. The tumor monopolizes nutrients. The body consumes its own muscles, including the heart. Organs fail.
Does dying hurt? Half of all patients who die conscious and in a hospital, a 1995 study found, suffered moderate to severe pain. But there is no excuse for that, says Sloan-Kettering’s Foley. Doctors have a whole arsenal of weapons to ease the final days: pain medication, anti-depressants, anti-nausea and anti-constipation drugs, appetite stimulants. Their use is not as widespread as it should be, due largely to the ignorance of many physicians. However death comes, when it finally arrives the patient’s pupils widen, for the last time, into still, black circles. The skin takes on a grayish pallor. One by one, cells cease all biological activity. Life flickers out. The dying is over.
Conditions that weaken the heart muscle and its pumping action can cause congestive heart failure (CHF). If the diminished function of the heart worsens, the signs and symptoms of CHF become more severe. In the final stage, when the heart is no longer capable of pumping enough blood to the body, dying from congestive heart failure is the result.
The Stages of Congestive Heart Failure
According to MedlinePlus, when the heart cannot pump blood effectively, the blood backs up in areas of the body. This causes fluid congestion in various tissues and compartments in the body. There is no cure for CHF so, as the disease progresses, signs and symptoms get worse and other organs start to fail. With congestive heart failure, death can follow the more severe final stages.
To grade the increasing severity of congestive heart failure, doctors use the New York Heart Association class I to IV or the American Heart Association/American College of Cardiology stages A to D.
Initial Stages of CHF
In the initial, mild stage A, there are underlying high-risk factors for CHF such as smoking or high blood pressure. However, the affected person has no symptoms or limitations at rest or with physical activity and there are no signs of CHF on evaluation by a doctor.
In stage B, the person develops mild symptoms of fatigue, shortness of breath, or heart palpitations with routine physical activity. There are minor signs of heart dysfunction on a doctor’s evaluation. There might also be a mild, intermittent collection of fluid, known as edema, in the ankles and feet.
Moderate Stage of CHF
At Stage C, as the heart continues to fail, the person develops weakness and significant fatigue, shortness of breath or palpitations with the slightest physical exertion. She begins to limit activity because of these symptoms as she is only comfortable when resting. A doctor’s evaluation and testing shows moderate signs of heart dysfunction,
Other possible symptoms might include more visible edema of the lower extremities and the hands might also swell as the fluid congestion in body tissues increases. Shoes and rings might be tighter. The pulse might become weaker because of the struggling heart.
Severe or End-Stage CHF
By stage D or advanced CHF, a person progresses toward death as her heart failure gets worse. Despite treatment, symptoms are severe even at rest and any physical activity makes them worse. At this stage, the function of the heart and lungs is severely compromised.
With increasing fluid congestion in end-stage CHF, more fluid builds up in several areas of the body and backs up into the lungs. On physical exam and testing, such as a chest X-ray, there are signs of severe lung and heart disease. The Mayo Clinic describes some of the following symptoms and signs of dying of congestive heart failure:
- The affected person can begin feeling anxious, restless, unable to sleep, and loses her appetite.
- She has to keep her head elevated on pillows or sleep upright in a chair.
- The person can become more and more confused and disoriented, exhausted and weak as CHF death nears.
- There is weakness, fatigue, and severe shortness of breath at rest, as well as increasingly shallow, difficult, labored breathing.
- Respiratory distress progresses as the lung tissue becomes more and more congested with fluid.
- She might have wheezing and chronic cough with spitting up phlegm because of fluid in her lung sacs. Rattling in the chest with each breath can occur as death approaches.
- The heart might be enlarged, the rate faster than normal, and the pulse weaker because of the exhausted heart.
- There is marked, persistent edema of the feet, ankles, legs, and thighs.
- The hands and face become more swollen with fluid.
- The abdomen gets bigger and bloated from fluid collection inside the belly.
- Weight gain of three or more pounds a day occurs because of the increased fluid retention.
- Electrolyte levels become abnormal and contribute to the cause of death.
- The urine becomes concentrated and dark and urine output decreases and stops as the kidneys fail.
As death nears it the doctors will find it more and more difficult to get rid of the excess fluid in the lungs and belly, and around the heart. The extra load on the diseased heart leads to complete heart failure and death. Some people might also die suddenly because of an irregular heart rhythm.
Causes of CHF
Conditions that can damage heart muscle and lead to congestive heart failure include:
- Untreated or poorly treated high blood pressure and defective heart valves which can strain the heart
- Coronary artery disease which decreases blood to the muscle fibers of the heart
- A heart attack that causes scarring of heart muscle
- Infections of the heart muscle or heart valves
- Problems such as diabetes, thyroid, liver, kidney, and lung disease
Management of CHF
Management of CHF depends on the stage and symptoms. Initial therapy is aimed at any underlying cause of the disease process. In the later stage D, it is important to try to reduce extra body fluid that stresses the heart. Treatment options include:
- Medicines that improve heart function and oxygen therapy as needed
- Diuretics to try to increase urine output to decrease the fluid accumulations
- Decreased salt intake because extra salt holds on to fluid in the body
- Fluid restriction: In the early stages if the person is still able to drink, she is restricted to about four glasses a day otherwise her IV fluids might be kept low.
- Doctors might consider a pacemaker or heart transplant if appropriate.
As the disease advances and symptoms get worse, doctors might continue to remove fluid from the belly to improve comfort. When treatment options no longer work, and the person gets near to death, management is geared to making her feel comfortable. According to the American Heart Association, the patient and family should consider the need for palliative or hospice care ahead of this juncture.
Early Attention to Heart Disease
Congestive heart failure is one of the leading causes of death in the elderly and is not curable. The best course is to avoid or treat early known causes of the disease to prevent or limit damage to the heart. See your doctor if you notice early signs that might indicate CHF such as shortness of breath or fluid in your legs.
Wound Care Solutions
Every year, roughly 670,000 Americans are diagnosed with heart disease – that’s more than one a minute. In the time it takes you to read this article, half a dozen individuals will have experienced a major shift in their quality of life. Heart disease is the leading cause of hospitalization in people over 65, and the #1 killer of both men and women in the U.S. It’s more deadly than all forms of cancer combined, and while there are many different types of heart failure, congestive heart failure is particularly complex.
What is Congestive Heart Failure (CHF)?
Congestive heart failure (also known as CHF) is a chronic progressive condition that affects the pumping power of the heart muscles. In patients with CHF, fluid builds up around the heart, limiting its ability to pump efficiently. Left untreated, CHF can lead to serious health problems, even death.
How the heart works
A heart has four chambers – an upper half with two atria and a lower half with two ventricles. The ventricles pump blood to your organs and tissues, the atria receive blood as it circulates back from the rest of your body. In CHF patients, the ventricles can’t pump enough blood to the body. As a result, fluid builds up in the lungs, abdomen, liver, and other vital organs, causing the body to become “congested,” hence the name “congestive heart failure.”
What causes CHF?
According to the Mayo Clinic, there are 5 main things that can lead to heart failure.
Coronary artery disease and heart attack. When arteries narrow due to cholesterol and a buildup of plaque and fatty deposits, they can restrict blood flow to the heart. If a total blockage occurs, the resulting trauma is known as a heart attack and can leave the heart muscle in a weakened state, unable to perform efficiently.
High blood pressure (hypertension).In a patient with high blood pressure, the heart has to work harder to circulate blood throughout the body. Over time, the muscle may become too stiff or too weak to effectively pump blood.
Cardiomyopathy. In simple terms, cardiomyopathy is damage to the heart muscle. It has many causes including disease, infection, alcohol and drug abuse. Genetics can also play a role. The end result is inefficient blood flow from a muscle in a weakened state.
Valve conditions. Heart valves keep blood flowing in the proper direction. A damaged valve – due to a heart defect, coronary artery disease, or heart infection – forces the heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken the heart, leading to CHF.
Other conditions. Other conditions, either from birth (such as congenital heart defects), contracted (such as HIV or myocarditis resulting from a virus), or developed over time (such as diabetes, hemochromatosis, or amyloidosis) can also lead to CHF. In essence, any condition which forces the heart to work harder to pump blood through the heart can lead to heart failure.
What are the symptoms of CHF?
What are the symptoms of CHF? What should you be looking for and how do you know if a patient might be suffering from this particular condition?
Well, the first thing to note is that the symptoms of heart failure exist on a spectrum that can run from mild to moderate to severe. Symptoms can come and go and worsen over time, making CHF difficult to diagnose, but here are some of the most common things to look for, according to the American Heart Association.
Signs and Symptoms of Congestive Heart Failure (CHF)
By themselves, any one sign of heart failure may not be cause for alarm, but if a patient is exhibiting more than one of these symptoms, it’s important that they report them to a healthcare professional immediately and request an evaluation of the heart.
Facts about CHF you need to know
Despite being such a prevalent condition, is still a lot of confusion about congestive heart failure. Heart Failure Matters, a website developed under the direction of the Heart Failure Association of the European Society of Cardiology, tests your knowledge of some of the most common myths and facts. Can you identify which are which?
Heart failure means your heart has stopped beating.
MYTH: Heart failure does not mean your heart has stopped beating. Heart failure occurs when your heart muscle or valves have been damaged and your heart is not able to pump blood as efficiently as it should.
Heart failure can kill.
FACT: Heart failure is a very serious condition and can be fatal. However, by working with your doctor and medical practitioners you can get effective treatments and make changes to your lifestyle that will both ease your symptoms and prolong your life.
Heart failure is common.
FACT: Currently up to 14 million people in Europe (and nearly 6 million Americans) have heart failure and this number is rising all the time.
Heart failure cannot be treated.
MYTH: There are many treatments available for heart failure that are very effective at reducing symptoms and delaying the progression of the condition.
If you have heart failure you shouldn’t exercise.
MYTH: It is very important for people with heart failure to exercise. However, it is also important to not overdo it. The right amount of exercise can help to improve blood flow and alleviate symptoms.
Heart failure is a normal consequence of getting old.
MYTH: Although most people with heart failure are elderly, heart failure is not necessarily a part of the aging process. In fact, CHF is a serious cardiovascular condition that can be prevented and greatly helped with available treatments.
Need access to medical equipment and products to address CHF or other conditions? Visit Wound Care Solutions and discover our range of durable medical equipment.
Heart Failure: Understanding Heart Failure: Management and Treatment
How is heart failure treated?
Your treatment will depend on the type of heart failure you have and, in part, what caused it. Medications and lifestyle behaviors are part of every patient’s treatment plan. Your healthcare team will talk to you about the best treatment plan for you. Learn more about heart failure treatment.
What are the stages of heart failure?
Heart failure is a chronic long-term condition that gets worse with time. There are 4 stages of heart failure (Stage A, B, C and D). The stages range from “high risk of developing heart failure” to “advanced heart failure,” and provide treatment plans. Ask your healthcare provider what stage of heart failure you are in. These stages are different from the New York Heart Association (NYHA) clinical classifications of heart failure (Class I-II-III-IV) that reflect the severity of symptoms or functional limits due to heart failure.
As the condition gets worse, your heart muscle pumps less blood to your organs, and you move toward the next stage of heart failure. You cannot go backwards through the stages. For example, if you are in Stage B, you cannot be in Stage A again. The goal of treatment is to keep you from progressing through the stages or to slow down the progression.
Treatment at each stage of heart failure may involve changes to medications, lifestyle behaviors, and cardiac devices. You can compare your treatment plan with those listed for each stage of heart failure. The treatments listed are based on current treatment guidelines. The table outlines a basic plan of care that may apply to you. If you have any questions about any part of your treatment plan, ask a member of your healthcare team.
Stage A is considered pre-heart failure. It means you are at high risk of developing heart failure because you have a family history of heart failure or you have one of more of these medical conditions:
- Coronary artery disease
- Metabolic syndrome
- History of alcohol abuse
- History of rheumatic fever
- Family history of cardiomyopathy
- History of taking drugs that can damage the heart muscle, such as some cancer drugs
Stage A treatment
The usual treatment plan for patients with Stage A heart failure includes:
- Regular exercise, being active, walking every day
- Quitting smoking
- Treatment for high blood pressure (medication, low-sodium diet, active lifestyle)
- Treatment for high cholesterol
- Not drinking alcohol or using recreational drugs
- Angiotensin converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB) if you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions
- Beta-blocker if you have high blood pressure
Stage B is considered a pre-heart failure. It means you have been diagnosed with systolic left ventricular dysfunction but have never had symptoms of heart failure. Most people with Stage B heart failure have an echocardiogram (echo) that shows an ejection fraction (EF) of 40% or less. This category includes people who have heart failure and reduced EF (HF rEF) due to any cause.
Stage B treatment
The usual treatment plan for patients with Stage B heart failure includes:
- Treatments listed in Stage A
- Angiotensin converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) (if you aren’t taking one as part of your Stage A treatment plan)
- Beta-blocker if you have had a heart attack and your EF is 40% or lower (if you aren’t taking one as part of your Stage A treatment plan)
- Aldosterone antagonist if you have had a heart attack or if you have diabetes and an EF of 35% or less (to reduce the risk of your heart muscle getting bigger and pumping poorly)
- Possible surgery or intervention as a treatment for coronary artery blockage, heart attack, valve disease (you may need valve repair or replacement surgery) or congenital heart disease
Patients with Stage C heart failure have been diagnosed with heart failure and have (currently) or had (previously) signs and symptoms of the condition.
There are many possible symptoms of heart failure. The most common are:
- Shortness of breath
- Feeling tired (fatigue)
- Less able to exercise
- Weak legs
- Waking up to urinate
- Swollen feet, ankles, lower legs and abdomen (edema)
Stage C treatment
The usual treatment plan for patients with Stage C HF-rEF includes:
- Treatments listed in Stages A and B
- Beta-blocker (if you aren’t taking one) to help your heart muscle pump stronger
- Aldosterone antagonist (if you aren’t taking one) if a vasodilator medicine (ACE-I, ARB or angiotensin receptor/neprilysin inhibitor combination) and beta-blocker don’t relieve your symptoms
- Hydralazine/nitrate combination if other treatments don’t stop your symptoms. Patients who are African-American should take this medication (even if they are taking other vasodilator medications) if they have moderate to-severe symptoms.
- Medications that slow the heart rate if your heart rate is faster than 70 beats per minute and you still have symptoms
- Diuretic (“water pill”) may be prescribed if symptoms continue
- Restrict sodium (salt) in your diet. Ask your doctor or nurse what your daily limit is.
- Keep track of your weight every day. Tell your healthcare provider if you gain or lose more than 4 pounds from your “dry” weight.
- Possible fluid restriction. Ask your doctor or nurse what your daily fluid limit is.
- Possible cardiac resynchronization therapy (biventricular pacemaker)
- Possible implantable cardiac defibrillator (lCD) therapy
If the treatment causes your symptoms to get better or stop, you still need to continue treatment to slow the progression to Stage D.
Stage D and reduced E
Patients with Stage D HF-rEF have advanced symptoms that do not get better with treatment. This is the final stage of heart failure.
Stage D treatment
The usual treatment plan for patients with Stage D heart failure includes:
- Treatments listed in Stages A, B and C
- Evaluation for more advanced treatment options, including:
- Heart transplant
- Ventricular assist devices
- Heart surgery
- Continuous infusion of intravenous inotropic drugs
- Palliative or hospice care
- Research therapies
Stages C and D with preserved EF
Treatment for patients with Stage C and Stage D heart failure and reserved EF (HF-pEF) includes:
- Treatments listed in Stages A and B
- Medications for the treatment of medical conditions that can cause heart failure or make the condition worse, such as atrial fibrillation, high blood pressure, diabetes, obesity, coronary artery disease, chronic lung disease, high cholesterol, and kidney disease
- Diuretic (“water pill”) to reduce or relieve symptoms
YOU ARE THE MOST IMPORTANT PART OF YOUR TREATMENT PLAN!
It is up to you to take steps to improve your heart health. Take your medications as instructed, follow a low-sodium diet, stay active or become physically active, take notice of sudden changes in your weight, live a healthy lifestyle, keep your follow-up appointments, and track your symptoms. Talk to your healthcare team about questions or concerns you have about your medications, lifestyle changes or any other part of your treatment plan.
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Even for Advanced HF, there are treatment options
When heart failure (HF) progresses to an advanced stage, difficult decisions must be made. Do I want to receive aggressive treatment? Is quality of life more important than living as long as possible? How do I feel about resuscitation?
For advanced heart failure patients and their doctors, making good decisions requires teamwork. Through shared decision-making, doctors and patients consider both the options and the patient’s preferences before charting a treatment course.
What is advanced heart failure?
Of the more than 6 million Americans living with heart failure, about 10 percent have advanced heart failure. In short, that means conventional heart therapies and symptom management strategies are no longer working. Someone with advanced heart failure feels shortness of breath and other symptoms even at rest.
In the American Heart Association and American College of Cardiology’s A-to-D staging system, advanced heart failure is stage D. Another classification system, developed by the New York Heart Association, grades the severity of symptoms on a 1-to-4 scale. Your symptom severity number can fluctuate, even within a single day, depending on how you feel.
In its early stages, medication and a healthy lifestyle can help manage heart failure. But as the disease progresses and the heart becomes weaker, treatment gets more complex. That’s the time to have difficult, yet important, conversations with your family and your doctor about the care you want to receive.
When heart failure progresses to an advanced stage, there are still many treatment options. The decisions – ranging from “do everything possible” to “strive for comfort” – aren’t easy. That’s why the American Heart Association released recommendations that serve as a roadmap to decision-making in advanced heart failure.
The goal? A partnership between you and your doctor, where medical options are honestly discussed, and decisions are made based on what you want. Shared decision-making means you don’t have to make decisions on your own.
Doctor-patient conversations about treatment options, their risks and benefits as well as future “what-if” scenarios should happen early and often, according to experts who helped draft the AHA recommendations. This early dialogue means you’re not blindsided when a big medical event happens that requires tough decision-making.
Doctors provide the medical facts and figures, while you provide your personal goals and preferences. Together – and often with input from family and friends – you and your doctor build a care plan.
- An annual heart failure review to discuss how well you are functioning, current treatment goals and your preferences for treating possible emergencies, such as kidney failure or sudden cardiac arrest.
- “Milestone” discussions to reassess treatment goals following a major event, such as a defibrillator shock, hospitalization or significant loss of function.
- Honest and thorough conversations about major side effects of treatment, quality of life, loss of independence, impact of worsening symptoms and increased commitment by caregivers and families.
- Considering palliative care, offered alongside medical treatment, to help manage symptoms and assist you and your family with tough decisions. Developing a care plan for the end of life that ensures your needs and wishes are met.
Living with advanced heart failure is difficult, and the medical decisions can be complicated. With shared decision-making, you can avoid heat-of-the-moment decisions and instead take time to figure out what’s best for you.
When Vickie N. stepped on a stone while doing yard work in the summer of 2015, the last thing she was thinking about was her heart. And why would she? At age 48, she was healthier than she’d been in a long time — finding out she had type 2 diabetes had motivated her to become vigilant about diet and exercise.
“Over the last 10 years, I’ve lost about 160 pounds,” she says. “I went from a size 22-24 to a size 10. So I really worked on myself, followed a healthy diet, and worked out on my elliptical machine and exercise bike a few times a week.”
Vickie was an independent, on-the-go woman. She owned a hair salon where she worked between 10 and 12 hours a day. Instead of relaxing like many parents do when their kids leave the nest, when her 23- and 21-year-old sons left to join the Navy and Marines, respectively, the Texas native became a foster parent and started taking in children ages 5 and under.
On top of all that, she was also in the process of going through a divorce, so she had begun renovating a rental property for her and her foster children to move into in the near future.
Then Vickie stepped on that stone. She developed a sore on her left foot. At first it seemed to be healing, but after walking barefoot through steel rainwater on her porch, Vickie noticed swelling. She visited her doctor, who referred her to a podiatrist.
A (Scary) Blessing in Disguise
Vickie was given a shocking diagnosis. “The doctor took the bandage off my foot and said, ‘You either go to the hospital to have surgery or you lose your leg — these are your options!'” she remembers. “The infection had gotten so bad within days that I was close to losing my leg from the knee down. I couldn’t believe this was happening to me.”
With no other choice, Vickie had surgery, where doctors removed half of her heel; however, when she woke up, she learned that her health crisis was far from over.
“I found out that I’d had a massive heart attack,” she says. “My doctors couldn’t believe I wasn’t experiencing shortness of breath. Plus, I had a bone infection and still could be losing my leg.”
Vickie with her sons, Zackary and Steve. Courtesy of Vickie N.
Vickie’s heart was pumping blood at roughly 5% — the average is around 55 to 60%. Her doctors struggled to find a cardiologist who was willing to work with someone whose heart was in such a weak state. During the waiting period, Vickie’s sons were given clearance to fly home to see her.
“They were told it was a matter of life or death,” she says tearfully. “It was amazing to see them because I didn’t know if I’d ever see them again.”
The Life-Saving Procedure
“Vickie’s case was a little more complicated because she had bad blockages in all three arteries — she was in full heart failure,” says Chad D. Christopherson, MD, chief of cardiology at Baptist Medical Center in San Antonio, Texas.
Her poor circulation was directly connected to her foot and leg problem. “She wasn’t providing adequate blood supply to her foot to heal the wound,” he explains. “The reason the fluid builds up is because the heart can’t pump the blood around, and so it backs up into the lungs, the abdomen, and the legs.”
Even though Vickie says she didn’t notice any red flags, Dr. Christopherson isn’t so sure. “We all do a very good job of explaining things away,” he says.
A few of the common symptoms of heart failure include a decrease in your exercise ability — “I don’t mean having a hard time running on a treadmill, I’m talking about noticing a significant change in walking from the car to the grocery store” — hands and feet feeling colder than usual, nausea for no reason, chest discomfort, and fluid retention.
I am so young and I have everything to live for.
“Because Vickie is a hairdresser, she assumed her ankles were swollen because she stands all day,” he says. “She also assumed she was tired from not getting enough sleep.”
Christopherson performed a Protected PCI procedure on Vickie, which uses a small pump (called the Impella pump) to temporarily push blood through your heart while stents (tiny tubes that open up blocked arteries) are inserted. ” was about a three-hour process and we put in six stents,” Christopherson says.
Taking Her Life Lessons to Heart
Vickie was released from the hospital in mid-July 2015 and was back to work in early August. Today, her heart is functioning at 35%.
“Anything above 35% is when you’re getting back into the normal prognosis,” Christopherson explains.
Vickie’s foot is on the mend and she’s even lost a few more pounds — she now wears a size 6. “I was putting on weight, but now I know it was water weight from the swelling,” she says.
PROTECT YOUR HEART
She’s also taking strides to reduce the stress in her life — and one way she’s doing that is by sharing her story. “I’m learning to vocalize more,” she says. “What I went through was life-changing — it made me stronger. I’m speaking up by letting people know what happened to me.”
She encourages those closest to her to eat healthier, head to the gym, and make an appointment with a cardiologist to have a heart sonogram, regardless of their genetic background. “Diabetes runs in my family, but heart disease does not,” Vickie says.
But most of all, she makes a point to appreciate opening her eyes every morning. “I’m feeling fantastic,” she says. “I am so young and I have everything to live for. My boys need me, foster children need me, I have my mom, my brother, and more family, lots of friends, I have clients for 30 years. With everything I have endured the last few years, I am just so excited to live my everyday life!”
Amy Capetta Amy Capetta has been writing health and lifestyle articles for over 15 years.
Living with Heart Failure
Heart failure is a condition in which the heart is not working as well as it should due to difficulty pumping blood, either from being too weak or too stiff. As a result, the heart, organs and tissues cannot receive an adequate supply of blood, making it more difficult to do activities that may have been easy in the past. Getting acquainted with how the heart works may help in understanding how heart failure occurs and what a person can do about it.
Heart Failure: Knowledge for Effective Self-Care
Heart failure is a progressive and chronic condition in which the heart’s muscle is weakened and may no longer pump effectively. Heart failure has different causes, including:
- Blocked arteries in the heart
- Heart attack
- High blood pressure
- Heart valve problems
The heart function and type of heart failure can be measured by having an echocardiogram, a test that provides images of the heart.
When the heart muscle is weakened, the body compensates by working harder, which causes the heart walls to become thicker, and the heart becomes enlarged. This also causes stress hormones to be released, which cause the arteries to tighten. The tightened arteries make it even more difficult for the heart to pump. In addition, the stress hormones cause the kidneys to hold onto salt and water, which increases the amount of blood that must be pumped. It is important to take medications regularly to block the actions of these hormones and to make it easier for the heart to pump.
Types of Heart Failure
Systolic Heart Failure
Systolic heart failure is diagnosed when the echocardiogram shows that not enough blood is being pumped by the heart. The amount of blood being pumped is called the ejection fraction. If this is less than 50 percent, it is weak and results in systolic heart failure. After an injury, the heart cannot pump the amount of blood the body needs. The blood backs up into the lungs, which causes shortness of breath, and/or backs up into other parts of the body which causes swelling in the legs. These symptoms can be controlled with medications and a low-sodium (salt) diet.
Diastolic Heart Failure
Diastolic heart failure is diagnosed by an echocardiogram showing a stiff heart. In this case the heart cannot relax, so it cannot properly fill with blood to circulate to the body. This causes increased pressure and blood to back up in the lungs, liver, legs and other areas of the body, causing symptoms of swelling, shortness of breath and the inability to tolerate activity. These symptoms also can be controlled with medications and a low-sodium (salt) diet.
Valvular Heart Failure
Valvular heart failure is caused by either a backward flow of blood, a leaky valve in your heart, or a narrowing of the valve area through which blood can flow. These are both abnormalities of the heart valves. This may cause the heart muscle to weaken and pump less effectively, and/or can cause increased pressure in the lungs.
Heart Failure Medications
Medications play an important role in the treatment of heart failure. Research shows that heart failure medications can stabilize the function of the heart, slow down the progression of heart failure and even improve heart function. Always stick to the medication plan unless you are instructed otherwise by a healthcare provider. Following a prescribed medication plan can:
- Help extend life
- Alleviate symptoms
- Make breathing easier
- Increase energy and activity levels
- Alleviate swelling in the legs or ankles
- Reduce hospital readmissions
Types of Medications
Beta blockers are a class of drugs that block certain hormones that can put stress on the heart. These stress hormones can cause high blood pressure and/or a fast heart rate. Beta blockers slow heart rate and widen (dilate) arteries, which lowers blood pressure. They allow a stiff heart more time to relax so it can properly fill with blood. Also, by widening the arteries, there is more blood flow to the kidneys. It is important to remember that beta blockers are beneficial to the heart even if there is not a fast heart rate or high blood pressure because they decrease the hormones that can put stress on the heart.
ACE (Angiotension Converting Enzyme) inhibitors make it easier for the heart to pump by widening the blood vessels. ACE inhibitors limit the amount of stress hormones in the body. Stress hormones may cause tightening of arteries, increasing the blood pressure and the workload of the heart. Like beta blockers, ACE inhibitors decrease the amount of stress hormones in the body that can worsen heart failure. The long-term effects of ACE inhibitors can slow the progression of heart failure and improve symptoms. ACE inhibitors can increase the amount of blood the heart pumps or ejection fraction over time.
Angiotensin receptor blockers, also known as ARBs, are a medication for patients who cannot tolerate ACE inhibitors. Like ACE inhibitors, ARBs block certain stress hormones from tightening the arteries, thus decreasing the stress hormones which can negatively affect the heart. Diuretics, often called “water pills,” help the body get rid of extra fluid, so there is less fluid for the heart to pump. Diuretics decrease the swelling in the legs and feet and an improve breathing. Most diuretics lower potassium levels, an important electrolyte for the heart, and increase urination, so these should be taken as advised by a physician. Digoxin is a class of medications that help the heart pump slower and more effectively. This drug may not be appropriate for all types of heart failure patients. Aldosterone antagonists are a group of medications that block a hormone called aldosterone, which causes fluid retention and can make the symptoms of heart failure worse. Aldosterone antagonists are a type of diuretic that prevent the body from losing potassium. Lab work may be ordered when starting this medication.
In addition to taking medications to control heart failure, there are other lifestyle changes that can be made, including reducing fluid intake. Fluid is necessary to keep the body functioning properly. However, in heart failure extra fluid builds up in the body, which makes the heart work harder. Restricting fluid intake can help limit the build-up of fluid in the body. Intake of fluid may be limited to 1.5 to 2 liters, which equals 1,500 to 2,000 ml or six to eight cups of fluid per day. Count all fluids that are consumed, including water, coffee, tea, juice, milk, soft drinks, ice cubes, soup and fluids. Also include the fluids in foods that become liquid at room temperature, such as Jell-O, sherbet, ice pops and ice cream.
If limited to 2,000 ml or 2 liters, use a 2-liter container to help measure fluid consumption. Before drinking anything, remember to measure and pour the same amount of fluid into the container. This will help keep track of how much fluid intake is left for the day. Be sure to use the fluid allowance evenly throughout the day and save enough fluid to take the medicines needed later in the day. Patients with a dry mouth can,
- Suck on hard, sugar-free candy, a lemon wedge, frozen orange sections, frozen grapes, or chew gum to moisten the mouth. Frequently brushing teeth will also help moisten the mouth.
- Prepare a measured amount of ice chips and flavor with lemon or lime juice, if desired. This still counts as fluid, but ice melts to about half its original amount so you will be more refreshed than drinking the same amount of beverage. (Example: 1 cup ice = ½ cup fluid).
Sodium restriction is another important lifestyle change for managing heart failure. That means it will be easier to manage heart failure symptoms by reducing the sodium in a diet. The recommended amount of sodium for heart failure patients is 2,000 milligrams daily. Heart failure patients should avoid adding table salt or sea salt to food or cooking. One teaspoon of salt has about 2,300 milligrams of sodium – more than the daily recommended amount. Fresh or dried herbs or spices may be used to season food, or a salt substitute.
Heart failure patients should keep track of their weight. A weight gain of as little as two to three pounds may be a signal that any medications may need to be adjusted or cause to call the physician’s office. It is best to record weight at the same time every day in the same state of dress or undress.
Heart Failure Devices
The heart has its own special electrical system that enables the heart to beat and pump. There are special cells in the heart that create electrical impulses. These electrical impulses begin in the right atrium, the heart’s natural pacemaker, and spread through the entire muscle, causing it to contract. If the heart’s electrical system does not follow the normal pathway to generate a heartbeat that causes the chambers to work together, the heart may not pump effectively. The regular contractions are what we know as heartbeats. Sometimes heart failure is related to problems with the electrical system in the heart. As a result, irregular beats or other abnormalities may occur.
Internal Cardiac Defibrillator (ICD)
Those with weakened heart muscles and a low ejection fraction may be at risk for lethal arrhythmias or abnormal heart rhythms. Because of this, the physician could recommend an internal cardiac defibrillator (ICD), which is inserted through a small incision in the upper chest. Similar to a pacemaker, the ICD paces the heart back into a normal rhythm or delivers a shock to restore normal rhythm if a lethal rhythm abnormality occurs.
Bi-ventricular Pacemakers or Bi-ventricular ICD
If the heart shows signs of dysynchrony, meaning it doesn’t beat effectively, the doctor could recommend a bi-ventricular pacemaker or ICD. Pacemaker leads would be placed in both sides of the heart, helping it beat in sync and more effectively while protecting against potentially dangerous abnormal heart rhythms. This therapy has been shown in research to improve heart function, improve symptoms and improve quality of life with heart failure. Heart failure is a progressive and chronic disease, but with proper treatment and lifestyle changes, many patients will experience a full and rewarding life. Be sure to talk with a healthcare provider about other possible treatment options and how to manage heart failure, as they may have other suggestions and treatment options. As with any health improvement or recovery program, the outcome depends a great deal on what the patient can do regularly. Here are some areas that can make a difference in the overall health of a heart failure patient:
- Become informed. Develop a good understanding of your condition and be certain that you know exactly what you need to do to take proper care of yourself at home. Ask your physician and the other members of your healthcare team specific questions.
- Understand your prescriptions and treatment plan. Know the type, amount and frequency of your medication. Do not stop or change a medication unless you have consulted with your physician and have been directed to do so. Stop using tobacco if you use it and reduce any alcohol consumption to the least amount.
- Manage your fluid intake.
- Record your weight every day. Notify your healthcare professional if your weight increases by more than 2 pounds in 24 hours or if it increases by 3-4 pounds in 2 days.
- Monitor your blood pressure. Know your blood pressure. Keep a chart of your blood pressure. Notify your healthcare professional when your blood pressure changes significantly.
- Speak up. Follow your healthcare provider’s orders and communicate. Speak up if you have any questions or changes in your condition. If you experience discomfort or an unusual symptom, contact your physician. Keep your scheduled appointments with your doctor. Your doctor wants to help you do as well as possible but needs to be informed how you are doing to provide quality care. Do not hesitate to call.
- Stay active. If you are able, and only on the advice of your healthcare provider, you should plan to exercise. It will be important for you to have set times during the day for exercise. Research has shown that exercise may decrease symptoms and improve your quality of life. Ask your doctor if you are a candidate for cardiac rehabilitation.
- Reach out. It is important for you to maintain your friendships and interests, as well as develop new ones. Changes in your lifestyle habits can lead to other positive changes in your health.
For more information regarding the heart transplant program at Baylor University Medical Center, part of Baylor Scott & White Health, visit BSWHealth.com/HeartTransplant.
For additional information, visit Heart Failure Society of America and American Heart Association.
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End Stages of Heart Failure: What to Expect
Congestive heart failure is one of the most common reasons for hospital admissions for senior citizens. In fact, over 5 million adults in the United States experience heart failure.
Heart failure occurs when the heart muscle becomes damaged and can no longer pump blood effectively. Although symptoms can be managed, this is a chronic condition with no cure. In time, patients will reach the final stages of congestive heart failure.
Patients in the end stages of heart failure want to know what to expect. The symptoms of end-stage congestive heart failure include dyspnea, chronic cough or wheezing, edema, nausea or lack of appetite, a high heart rate, and confusion or impaired thinking.
Learn about the hospice eligibility requirements for end-stage heart failure.
What Do Symptoms of End Stage Congestive Heart Failure Look Like?
Dyspnea – or shortness of breath – can occur both during activity and rest. This is the symptom that often sends patients racing to the hospital late at night. Work with your hospice or palliative care team to manage symptoms at home and avoid these stressful hospital trips.
When the heart cannot keep up with the supply of blood moving between it and the lungs, fluid can build up in the lungs. This results in a chronic cough or wheezing that can produce white or pink mucus.
As the heart’s ability to pump slows down, fluid can build up in the body. This creates swelling in the extremities – particularly the feet, ankles, legs, or abdomen.
Lack of Appetite
As the digestive system receives less blood, patients may feel full or nauseous. Not wanting to eat is a natural part of the body shutting down, but families often find this distressing. Learn more about why it is okay for your loved one to stop eating and drinking at end of life.
High Heart Rate
In response to a loss in pumping capacity, the heart begins to beat faster. The patient experiences this as a racing or throbbing heartbeat.
When the heart stops working effectively, it can change sodium levels in the blood. This leads to memory loss, confusion, and a general feeling of disorientation.
Hospice and Congestive Heart Failure
When a heart failure patient has been diagnosed with six months or less to live, the added support of hospice care helps them remain in their home until end of life.
Crossroads Hospice & Palliative Care provides a team of nurses, aides, social workers, volunteers, and chaplains to support the patient and their family through the final stages of congestive heart failure symptoms. To learn more about referring your patient to hospice, please call Crossroads at 1-888-564-3405.