Caring at the crossroads: Exploring end-of-life challenges for advanced heart failure patients in saudi emergency departments

BACKGROUND: Patients with advanced heart failure often present to hospital emergency departments during acute health crises near the end of life. While emergency departments focus on medical stabilization, they may not adequately address the emotional, spiritual, and personal needs of patients during this critical period. METHODS: This qualitative study was conducted at a major tertiary hospital in Saudi Arabia. Semi-structured interviews were conducted with twelve patients diagnosed with advanced heart failure to explore their experiences of end-of-life care in the emergency department. Thematic analysis was used to interpret the data. RESULTS: Four key themes emerged. Cultural and religious influences shaped how patients perceived their illness and guided medical decisions, often involving strong reliance on faith and family. Patient readiness and awareness varied, influencing communication preferences and attitudes toward treatment. Care experiences in the emergency department reflected both appreciation for acute interventions and concerns about inadequate communication, privacy, and spiritual care. System-level barriers such as overcrowding, limited staffing, and the absence of structured advance care planning restricted the delivery of holistic, person-centered care. CONCLUSIONS: These findings highlight the need for culturally informed, communication-focused, and system-responsive approaches to end-of-life care in emergency departments, particularly within Saudi Arabia and comparable healthcare systems.