Heart Failure: End-stage management
Guideline number: QH-GDL-485
Effective date: 22 June 2026
Review date: 22 June 2029
Supersedes: Version 1
Heart failure is a progressive chronic condition, that can be unpredictable with uncertain timing of exacerbations, functional decline, and sudden death. Following exacerbations, patients often do not return to their previous level of function (see figure 1).
Integrating a palliative approach by identifying and addressing patient and family physical, psychological, spiritual, informational and social needs is appropriate throughout the heart failure trajectory, regardless of prognosis, and may be delivered by a range of clinicians. Goals of care should be reviewed regularly and adjusted as the condition progresses. Timely referral to specialist palliative care services is strongly recommended, especially for patients with end-stage heart failure.[1]
End-stage heart failure represents the advanced stage, characterised by persistent, severe symptoms despite optimal therapy. At this stage, care priorities often shift from disease modification to symptom management, quality of life, and psychosocial support for patients and families. Voluntary Assisted Dying (VAD) is also available to eligible Australian adults with advanced progressive heart failure causing intolerable suffering.
Given the unpredictability of heart failure, advance care planning should be initiated early, regardless of the patient’s clinical status, and reviewed over time.[1] In Queensland, preferences can be recorded using an Advance Health Directive, Enduring Power of Attorney (health and financial), and Statement of Choices. The Office of Advance Care Planning accepts these documents from all hospitals, health services, Residential Aged Care Facilities, and individuals (email to acp@health.qld.gov.au). Documents are uploaded to The Viewer.