Breathlessness in end-stage heart failure

Breathlessness is a common and distressing symptom in end-stage heart failure, impacting adversely on quality of life for both the patient and the carer. Breathlessness is recognized as being a multi-factorial subjective experience. Research into effective therapies is surprisingly sparse, although this is a common feature in the end stages of a number of diseases. A complex holistic assessment must first exclude a treatable underlying cause and ensure that medications have been optimized. A variety of both pharmacological and non-pharmacological therapies are available for breathlessness. Treatment is likely to require an approach incorporating both and addressing identified physical, social, psychological and spiritual needs to provide optimum relief. A skilled and experienced specialist cardiac nurse is ideally placed both to assess the breathlessness and to support the patient in finding effective therapies at the end of life.