End-of-Life Symptoms in Elderly Patients with Advanced Heart Failure

Advanced heart failure in elderly patients, particularly those around the age of 80, often involves not only the deterioration of cardiac function but also the failure of multiple vital organs such as the digestive system, kidneys, and brain. The following outlines the most common symptoms observed during this stage:

Cardiac Failure

Heart failure manifests in two primary ways: pump failure and right-sided heart dysfunction. Pump failure refers to a significant drop in the heart's ability to circulate blood effectively, resulting in reduced cardiac output per minute. Right-sided dysfunction leads to persistent low blood pressure, which compromises blood flow to peripheral organs. Pulmonary congestion becomes severe, causing extreme difficulty in breathing. In the advanced stages, patients are often unable to lie flat and require elevated positioning of the head, supplemental oxygen, or even continuous ventilator support. Prolonged congestion also leads to widespread edema, affecting not only the lower limbs but also the sacral region, thighs, face, and even the entire body.

Digestive System Failure

Many patients experience gastrointestinal congestion due to impaired blood flow, which significantly reduces digestion and nutrient absorption. This often results in poor appetite and progressive malnutrition. Conditions such as hypoalbuminemia, a low level of albumin in the blood, may develop due to chronic digestive insufficiency.

Kidney Failure

As systemic blood pressure drops and renal perfusion decreases, the body's response to diuretics becomes less effective. This often leads to an increasing reliance on higher doses of diuretic medications. Over time, this contributes to a rise in serum creatinine levels, eventually leading to oliguria (reduced urine output) or anuria (complete absence of urine production).

Cognitive and Neurological Decline

Chronic hypoxia or inadequate cerebral blood flow can lead to significant neurological and cognitive impairments. Patients may become increasingly drowsy, confused, or unresponsive. These symptoms are often early signs of terminal decline and require careful monitoring by caregivers and medical professionals.

Potential for Sudden Deterioration

In the final stages of heart failure, patients face a heightened risk of sudden clinical deterioration. Multi-organ failure can lead to rapid declines in vital signs and may result in sudden cardiac death. Close monitoring and palliative care support become essential during this time to ensure patient comfort and dignity.