Palliation of dyspnea in patients with heart failure.

Dyspnea is a subjective sensation, measurable by patient self-report on validated scales, and common in patients with heart failure--especially in later stages of the disease. When usual care is not sufficient to relieve refractory dyspnea, a palliative care referral can minimize this distressing symptom. Unfortunately, many clinicians are reluctant to consult palliative care teams because of the conflation of hospice, which requires the acceptance of death and refusal of curative treatment, with palliative care, which is a service focused on the provision of symptom control to any patient, regardless of prognosis. The evidence around various strategies for relieving refractory dyspnea in patients with heart failure is reviewed, and other benefits of early consultation with palliative care are mentioned.