According to the Centers for Disease Control & Prevention, more than 6 million adults are currently in some stage of heart failure. Heart failure occurs when the amount of blood pumped is not enough to sufficiently meet the body’s needs. Swelling and an accumulation of fluid in your legs, abdomen, and lungs are common for individuals suffering from heart failure. A common and irreversible form of heart failure is congestive heart failure.

What is Congestive Heart Failure 

Congestive heart failure (CHF) is a chronic and progressive disease that affects the pumping power of your heart muscle. Fluid builds up in the heart, and the result is a heart that cannot pump blood effectively. It is more common in seniors, but adults of any age, and even sometimes children, can develop this progressive, chronic condition. 

Contributing factors to heart failure include unmanaged high blood pressure or diabetes, a previous heart attack, and disease of the heart valve. Risk factors for developing heart failure include obesity, chronic kidney disease, alcohol abuse, and smoking.

In most cases, there is no cure once heart failure develops in an adult. However, treatment can reduce symptoms and improve quality of life. For example, diuretics can reduce extra fluid by increasing the need to urinate. Dietary changes including changing to a low-salt diet may also help the body as it works to rid itself of fluids. Other prescription medications can assist the heart in pumping blood or help the heart to contract with more force.

Signs and Symptoms of Heart Failure 

  • Fatigue/weakness/exhaustion
  • Having a difficult time catching your breath
  • Excessive or sudden weight gain
  • Swelling in your legs and feet, belly or lower back
  • A chronic cough 
  • Having a more difficult time breathing when lying down
  • Requiring multiple pillows to sleep comfortably
  • Increased heart rate or palpitations
  • Loss of appetite

What are the Stages of Heart Failure


A person who is diagnosed with congestive heart failure will walk through various stages. It’s important to understand these stages and speak with your doctor if you have risk factors that might contribute to heart failure. The disease can often be prevented through lifestyle changes and improved health. If you are diagnosed with heart failure, the best time to begin a treatment plan is in the earliest stage, as this is when more options are available to slow the progression of the disease and increase quality of life. 

Initial Stages of CHF

In the initial stage of congestive heart failure, a person is diagnosed due to the presence of underlying risk factors such as obesity, smoking or high blood pressure. Most individuals in this stage will only exhibit mild or even no symptoms.  Doctors typically recommend few or no limitations with regard to physical activity. In fact, physical activity may slow or even stop the progression of the disease. It is therefore often an important part of the treatment plan.  In this initial stage, you might show no signs of CHF during the evaluation by your doctor.

In stage B of this initial stage, mild symptoms begin to appear such as fatigue, shortness of breath, or heart palpitations. These things are often most prevalent following routine physical activity. Diagnostic testing may show minor signs of heart failure or a strained cardiovascular system. Minor to moderate swelling of the hands and feet is also common. 

Moderate Stage of CHF

The next stage is moderate congestive heart failure. In this stage, the heart continues to fail. Weakness and significant fatigue are common, as are shortness of breath or palpitations even after something simple such as a short walk or less strenuous housework. You may feel a strong desire to rest more, and this makes physical activity uncomfortable. Many people will begin to reduce or avoid even more moderate activity.  This can actually worsen symptoms and contribute to the progression of the disease. An evaluation by your physician will show increased damage to the heart and cardiovascular system in this stage. 

Many people exhibit more visible edema of the lower extremities and swelling of the hands as the fluid increases in the body’s tissues. Your favorite pair of shoes or wedding ring might feel tight and uncomfortable. Your pulse might weaken, resulting from your struggling heart.

Severe or End-Stage CHF

Advanced stage congestive heart failure is the beginning of the progression toward death. Treatments are much less effective, and symptoms are severe even while you are at rest. Even simple physical activity such as getting out of bed makes symptoms worse. At this stage, breathing and movement are difficult. Functioning of the heart and lungs is severely compromised.

More fluid builds up in several areas of the body and backs up into the lungs during this stage. Physical exams and diagnostic testing show signs of severe and irreversible heart disease and lung damage.  The Mayo Clinic lists several  signs of end stage congestive heart failure:

  • Feeling anxious, restless, unable to sleep.
  • A loss of appetite 
  • Sleeping is difficult. Elevating the head on pillows or sleeping upright in a chair is common
  • Confusion and disorientation 
  • Weakness, fatigue, and severe shortness of breath even while at rest
  • Breathing is shallow, slowed, labored
  • Respiratory distress progresses as the lung tissues are increasingly congested with fluids
  • Wheezing and chronic cough. Spitting up phlegm 
  • Rattling in the chest especially when death is near
  • The heart is enlarged
  • Heart rate is faster than normal, and the pulse is weaker. The heart is exhausted
  • Swelling of the feet, ankles and hands continues to increase
  • The abdomen is bloated from increased fluid collection inside the belly
  • Weight gain of three or more pounds a day occurs as a result of increased fluid retention.
  • Electrolyte levels are abnormal 
  • Concentrated and dark urine or a lessening of urine output 

When to Consider Hospice Care for CHF


Hospice can be appropriate for many types of end-stage heart disease, including congestive heart failure. When an individual begins to experience persistent, severe symptoms that interfere with their daily life, the hospice team helps the patient to manage pain and enjoy a higher quality of life. Hospice care is also often recommended for a person who is experiencing recurrent hospitalizations or complicated hospitalizations, such as multiple ICU stays.

Even if you are not yet ready for hospice care, having a discussion with your doctor early in the disease progression can help you to better understand your options and prepare for the future. Instead of providing a direct referral to hospice care, your doctor may develop a treatment plan that includes palliative care. This beneficial program compliments your treatment choices and can help you to manage any discomforts that might accompany certain medications or other congestive heart failure treatment recommendations. In palliative care, a person is also assisted in reviewing and preparing their future plans and options, so they are better prepared to tackle any challenges as the disease progresses. 

Salus Hospice Care for Congestive Heart Failure 

Salus Hospice is nationally accredited by the Joint Commission and your trusted choice for comfort care once you have entered end stage heart failure. Our professional team includes Doctors, Registered Nurses, Medical Social Workers, Counselors, Spiritual Advisors and Volunteers who are focused on working with you to create an individualized plan of care, reducing pain and helping you to better manage uncomfortable symptoms. Our hospice program follows an RN model of care, and our nurse’s caseloads are significantly lower than the national average. The end result is a personalized care experience whether you choose palliative care or hospice care. This results in a higher quality of life for you and your loved ones and more opportunities to make memories with the people you love and in the comfort of your home. 

Contact us today for more information about palliative care or hospice care for CHF and advanced heart failure. We’re here to help.