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Late Stage Congestive Heart Failure

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A total of 16 cases of respiratory disease were reported, including 9 cases of acute onset choking/asphyxia due to aspirated food. There were also 11 cases of gastrointestinal accidents, including 9 cases of gastric dilation/volvulus and 2 cases of gastrointestinal foreign bodies with perforation, and 14 cases of trauma, including suspected motor vehicle trauma and.

Caring For Someone With Heart Failure Towards The End Of Life

Please be aware – this information is for healthcare professionals.

You can use our My Learning form to reflect on how this page has helped with your continuing professional development.

If you’re a patient, or a family member or friend, you can find more information on heart failure from the British Heart Foundation .

Heart failure means the heart is not pumping blood around the body as well as it should. People with heart failure may have symptoms such as fatigue, breathlessness and oedema . Here, we’ll talk about knowing when a patient with heart failure is near the end of life, and how to support them.

This information is about supporting adults with advanced heart failure.

On this page:

Addressing Comorbidities And Consequences

There is a myriad of comorbidities common in HF patients that may contribute to the pathology of the cardiomyopathy itself and/or the patients clinical status. These are, in general, associated with worse outcomes. Pre-existing comorbidities are often compounded by the consequences of advanced HF, resulting in severe end-organ dysfunction.

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For Patients Speaking To Families

  • Education is key. Educate yourself first. By now, youve probably done some research online. It may be helpful to read and share our Hospice Family Discussion Guide. 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 everyones needs are met.
  • Take initiative. Remember, its 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.

Section I: Cancer Diagnoses

Stages of Congestive Heart Failure in 2020
  • Disease with distant metastases at presentation OR
  • Progression from an earlier stage of disease to metastatic disease with either:
  • a continued decline in spite of therapy
  • patient declines further disease directed therapy
  • Note: Certain cancers with poor prognoses may be hospice eligible without fulfilling the other criteria in this section.

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    Stage 2 Of Congestive Heart Failure

    Stage two of congestive heart failure will produce symptoms such as fatigue, shortness of breath, or heart palpitations after you participate in physical activity. As with stage one, lifestyle changes and certain medication can help improve your quality of life. Your doctor will discuss treatment with you and help you on your healthcare journey while living with CHF.

    Emotional Symptoms Towards The End Of Life

    People with heart failure may experience different emotions and feelings. They may feel:

    • up and down, with good days and bad days
    • like they lack control over their life
    • like it’s hard to cope with the reactions of others.

    People may not think heart failure is as serious as other illnesses, such as cancer. Patients with heart failure can look well even when they feel very ill.

    If a patient has anxiety or depression, their healthcare team will assess how it affects them and whether they need treatment, such as cognitive behavioural therapy or medication.

    You can support the patient by providing emotional care and helping them with activities to make them feel better, such as reading, going outside and listening to music or audio books. Find out more about providing emotional care.

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    Understanding End Stage Congestive Heart Failure

    Over 5 million adults across the United States experience heart failure, making this one of the most common reasons why seniors are subject to hospital admissions. Medical innovations have come a long way in helping seniors to live longer and enjoy greater health after a diagnosis of heart failure, but there still is no cure for this condition. It occurs when the heart cannot pump enough blood to sustain the body, and with time, all patients diagnosed with this condition will reach the final stage of the disease.

    In end stage congestive heart failure, palliative care or hospice is often called in to provide comfort and support to seniors. As they continue to live each day to the fullest, many question what they should expect. Understanding the symptoms of end stage heart failure can help seniors to feel better prepared for their path ahead.

    Cardiac Cachexia Or Anorexia

    Stages of Congestive Heart Failure – Stage D (End-Stage)

    Cardiac cachexia happens when a patient loses fat and muscle tissue. Patients with cachexia may lose their appetite and significant amounts of weight.

    Speak to a dietitian about managing cachexia and anorexia. They may suggest eating small, frequent meals or taking high calorie, high protein food and supplement drinks. Patients may need to avoid some fruit juices and food supplements, which can affect their medication.

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    When To Get Medical Advice

    See a GP if you experience persistent or gradually worsening symptoms of heart failure.

    Call 999 for an ambulance or go to your nearest A& E department as soon as possible if you have sudden or very severe symptoms.

    A number of tests can be used to help check how well your heart is working, including blood tests, an ECG and an echocardiogram.

    Approach To The Management Of Advanced Hf

    The management of advanced HF begins with 1) confirming that the patients clinical picture is consistent with advanced HF and 2) addressing treatable and/or reversible causes . After confirming the clinical syndrome of advanced HF, the central principles of management focus on treating symptoms, delaying progression, avoiding decompensations, and managing comorbidities. In tandem with this, is the continual assessment of the need for advanced therapies, principally orthotopic heart transplant and/or left ventricular support device . These topics will be covered in subsequent chapters. The overarching goal is to improve quality-of-life and prolong survival. What follows is an approach to the management of end-stage HFrEF.

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    Living With Congestive Heart Failure: What To Expect

    Yes, there are several lifestyle changes you should take into account if youve been diagnosed with congestive heart failure. But remember your diagnosis doesnt mean you should necessarily stop doing things you love.

    You are supposed to be exercising walking, biking, swimming, or doing light weight exercises, says Mountis. The American Heart Association recommends at least 30 minutes of moderate intensity aerobic activity at least five days a week for optimal heart health. Avoid exercises that make you feel breathless, and make sure to talk to your doctor before starting a new exercise routine.

    Your healthcare provider will also likely suggest dietary changes that can help reduce the swelling associated with congestive heart failure and slow the progression of the condition. Those changes may include following a low- or reduced-salt diet, or reducing how much fluid you drink to lessen the bodys water content.

    Other lifestyle changes that can slow the progression of heart failure include:

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    What Is Canine Congestive Heart Failure

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    At its core, congestive heart failure in dogs means that their blood is not being pumped adequately throughout the body.

    Like a human, a dogs body survives by the blood that gets pumped through its veins.

    Every part of the body relies on that blood to keep it alive, well, and healthy.

    When the blood does not reach those parts, different parts of the body suffer.

    Additionally, even if that blood does not go to the proper places, it still goes somewhere, leading to medical issues.

    Where it goes and the problems it causes depends on the type of CHF the dog has.

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    Being Careful About Treats

    Many dogs with this condition shouldnt be fed human food or lots of dog treats. They often struggle to digest food properly and you will want to adhere to a set diet for their needs. You might also need to make sure that your dog is not eating too much and gaining weight which can further tax your dogs heart during normal daily activities.

    What Are The Stages Of Congestive Heart Failure

    Congestive heart failure has few stages and with each stage the progression continues. The stages include-

    Class I- Here the patient gets diagnosed with heart failure. If medical treatment is started in the very initial stage, the progression can be controlled. Patients can do any kind of physical activity without any limitations.

    Class II- Patients are seen to have slight but limited physical capacity. It is seen that when patients get involved in increased activity, he gets fatigued and have severe chest pain along with palpitations. Once rest is taken the patient gets back his strength.

    Class III- Patients are seen to be easily fatigued. Patients experience chest pain along with palpitations. Even normal activities make them tired. However, if appropriate rest is followed they regain their strength.

    Class IV- This is the final stage of congestive heart failure. Patients are seen to be completely unable to do any form of activity. They have a discomfort and frequently complain of chest pain. Severe pain is experienced in the chest if any kind of physical activity is undertaken.

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    Talk To Them About Their Symptoms

    People with heart failure may feel worried about their symptoms, treatment or risk of dying suddenly. Reassure them by talking openly and honestly about their concerns. Speak to their cardiac or palliative care team if you need support. If the patient has a plan for managing symptoms or emergencies, they may feel less anxious.

    What Causes Heart Failure

    Heart failure and breathlessness in end stage care | Dr Kulasagaram Ranjadayalan

    Although the risk of heart failure doesnt change as you get older, youre more likely to have heart failure when youre older.

    Many medical conditions that damage the heart muscle can cause heart failure. Common conditions include:

    • Tobacco and recreational drug use.
    • Medications. Some drugs used to fight cancer can lead to heart failure.

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    Stage B Treatment Options

    While stage A CHF is managed with lifestyle changes, the treatment plan for stage B typically includes taking medications regularly. People at this stage should still make the same lifestyle changes as those appropriate for stage A. However, your doctor may also prescribe additional treatments such as:

    • Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, if you arent taking any as part of your stage A treatment plan
    • Beta blockers if youve had a heart attack and your EF is 40% or lower, if you arent taking any as part of your stage A treatment plan
    • Possible surgery or intervention as a treatment for coronary artery blockage, heart attack, valve disease, or congenital heart disease

    What Are The Signs And Symptoms Of Congestive Heart Failure

    Difficulty breathing or shortness of breath are the most common and distinctive symptoms of congestive heart failure.

    • Difficulty breathing may occur when a patient is at rest, during an activity, while lying flat, or even while waking up.
    • Chest pain is another common symptom seen in patients with congestive heart failure.
    • Due to water retention in the kidneys, patients will have a fluid overload in ankles, feet, stomach, and lungs, which is another key symptom seen in heart failure patients.

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    Whats The Systolic Heart Failure Life Expectancy

    Systolic heart failure is an insufficiency of a heart caused by the malfunction of its left ventricle. This kind of HF is characterized by a low ejection fraction , also taken into account in this heart failure life expectancy calculator.

    EF is given in percent, and should be equal to around 50-70%. Mortality increases as the ejection fraction value . The smaller the EF, the shorter the estimated survival.

    Unfortunately, plenty of studies proved that the mortality in patients with systolic heart failure and low EF is higher than in those with preserved EF.

    For example: 1 year mortality rate for low EF = 26%, and for the high EF = 22%.

    Mechanical And Surgical Management Of End Stage Heart Failure

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    Fig 11 presents a suggested algorithm for the treatment of patients with end stage heart failure. In patients with reduced LV function , sinus rhythm, left bundle branch block or echocardiographic signs of ventricular dyssynchrony and QRS width 120ms, who remain symptomatic despite optimal medical treatment, cardiac resynchronisation therapy using biventricular pacing improves symptoms and exercise capacity while decreasing hospitalisations and mortality.1,2,3,23,24,25 In the COMPANION trial, heart failure patients in NYHA class IIIIV with LVEF 35% and QRS width 120ms were randomised to optimal pharmacological treatment alone or in combination with either CRT or CRT plus implantable cardioverterdefibrillator .23 Importantly, while mortality was reduced in both device arms there was no significant difference in mortality between CRT and CRT/ICD. Therefore, currently available data indicate that the use of an ICD in combination with CRT should be based on the indications for ICD therapy.3

    Table 3Absolute and relative indications for heart transplantation

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    What To Expect During The Final Stages Of Congestive Heart Failure

    Heart failure refers to when the heart cant or doesnt work well enough to provide oxygen and nutrients to the parts of the body and brain that need them. This decrease in cardiac output means the heart isnt strong enough to move blood from the body and lungs back to the heart. This causes fluid to leak from capillary blood vessels.

    Shortness of breath, weakness, and swelling are some things that might happen because of this. Before we dive into the depths of the heart failure signs of death, lets understand what goes on in the body.

    What Should I Expect In The Last Few Days

    As the end of life approaches, you might experience a number of physical and emotional changes. These are different for everyone. You might notice changes over weeks, days or even hours. Some of the changes might be the same as signs of a flare-up, so discuss them with your doctor or nurse.

    Signs to look out for include:

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    What Are The Types Of Heart Failure

    There are many causes of heart failure, but the condition is generally broken down into these types:

    Left-sided heart failure

    Heart failure with reduced left ventricular function The lower left chamber of your heart gets bigger and cannot squeeze hard enough to pump the right amount of oxygen-rich blood to the rest of your body.

    Heart failure with preserved left ventricular function Your heart contracts and pumps normally, but the bottom chambers of your heart are thicker and stiffer than normal. Because of this, your ventricles can’t relax properly and fill up all the way. Because there’s less blood in your ventricles, your heart pumps out less blood to the rest of your body when it contracts.

    Right-sided heart failure

    Heart failure can also affect the right side of your heart. Left-sided heart failure is the most common cause of this. Other causes include certain lung problems and issues in other organs.

    Sympathetic Nervous System Activation

    Early Stages of Congestive Heart Failure (CHF)

    Under normal circumstances, the SNS is inhibited by the high-pressure baroreceptors and low pressure mechanoreceptors in the heart. In HF however, these inhibitory mechanisms are diminished due to increased pressure in the LV and reduced pressure at the level of the baroreceptor, resulting in over-activation of the SNS. Early on, this augments heart rate and contractility, helping to maintain cardiac output. However ultimately beta-adrenergic responsiveness decreases and norepinephrine stores are depleted, while increased hypertrophy, fibrosis, and myocyte necrosis ensue.

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    End Stages Of Heart Failure In Dogs

    The end stages of heart failure in dogs are the hardest for dog owners to endure. When the heart fails to pump as effectively as it should, a cascading chain of events takes place. While the body can try to compensate, and medications can help reduce strain on the heart, this will be effective only up to a certain extent. As the heart is forced to work more, a point will inevitably come where the heart is no longer able to pump correctly. Veterinary care at this point is still important. Your vet can suggest you a therapeutic plan and you should follow up to report the level of success of such intervention.

    Clogged arteries leading to heart disease is mostly seen in humans.

    When the Heart Fails

    In dogs, congestive heart failure is mostly caused by two heart conditions, namely valve degeneration and dilated cardiomyopathy .

    Congestive heart failure in dogs is a chronic condition that worsens over time. Although symptoms can be managed, there is no cure, and in time, affected dogs will unfortunately reach the final stages.

    When dealing with heart failure, therefore vets arenât really fixing anything, but just trying to relieve symptoms and delay the inevitable for as long as possible. Dogs with end stage heart failure are unfortunately on âborrowed time.â

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