Multidisciplinary Management of End-Stage Heart Failure

Heart failure is the end stage of cardiac disease, and despite new and more effective pharmacological and non-pharmacological therapies, the mortality rate remains high, and repeated admissions with further organ damage are common. Repeated hospitalizations predict mortality, and each hospitalization provides an opportunity for individualized discussion with the patient, family, and members of the hospital care team. The initial goals are improvement of clinical outcomes, mortality, and hospitalization. However, at the end stage of heart failure, the goal may change, and quality of life becomes particularly important. Patient education and implementing guideline-recommended therapy serve as the core of multidisciplinary management for the prevention of readmission. Toward the end stage of heart failure, managing cachexia, dyspnea, pain, agitation, and delirium also becomes increasingly important. In this issue, multidisciplinary intervention in the context of Japanese society is discussed.