Palliative symptom management in patients with heart failure

Effective symptom management is a critical component of quality palliative care. For those with heart failure, poorly managed symptoms contribute to frequent rehospitalization and significantly increase the overall burden to patients and families as well as the healthcare system. The purpose of this paper is to review assessment and management strategies for patients with heart failure who remain symptomatic despite guideline-indicated heart failure treatment. Initially, we focus on the Symptom Management Model as a guiding framework consistent with palliative care. Then, we address several specific symptoms commonly reported by heart failure patients, including dyspnea, fatigue, difficulty sleeping, depression and anxiety. Comprehensive, on-going assessment of symptoms and the symptom experience is critical to guide planning, intervention, and evaluation of patients with heart failure. Through targeted assessment and interventions, the burden of symptoms may be reduced to improve quality of life for patients and their families as they face this life-limiting, chronic illness.