Cardiac failure background

Heart failure is classified as either

1. Cardiac failure with Left Ventricular Systolic Dysfunction, (LVSD) (as seen on echocardiography)


2. Diastolic heart failure (with echocardiographic evidence of an ejection fraction of greater than 40-50%) also known as heart failure with:

  • Preserved ejection fraction or
  • Preserved systolic function or
  • Normal ejection fraction (‘HFNEF’)

Diastolic heart failure may occur in patients with hypertension, hypertrophic cardiomyopathy or aortic stenosis.

Cardiac failure can be described by stage according to the New York Heart Association (NYHA) classification:

NYHA Class



Cardiac disease not limiting physical activity; no symptoms with ordinary activity


Symptom-free at rest; slight limitation of physical activity; symptoms with ordinary activity but resolve with rest


Symptom-free at rest; ordinary activity markedly limited due to symptoms


Symptomatic at rest. Unable to carry out ordinary activity

50% of patients with heart failure (all classes) die within 4 years and 50% of those with class IV heart failure die within 1 year.

The physical and psychological symptom burden from heart failure in the dying phase is similar to that in the cancer patient in the dying phase.

Their frequency: Pain (78%), dyspnoea (61%), depression (59&), insomnia (45%), anorexia (43%), anxiety (30%), constipation (37%), nausea/vomiting (32%), fatigue (62-70%), difficulty ambulating, and oedema.


This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.

Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.

While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.