Introduction: The prognosis in refractory heart failure is extremely reserved, with high mortality despite the therapeutic advances of drug, interventional and / or surgical treatment. It is necessary to integrate and de-velop palliative care programs into the structure of the community healthcare network under the conditions of demographic dynamics and due to increased morta-lity through non-oncological diseases.
Methods: We present the case of a 47-year-old pati-ent with a history of pulmonary tuberculosis, a former smoker, with hypertension, coronary artery disease, insulin-treated diabetes, at the stage of chronic mi-cro- and macrovascular complications, with significant post- tuberculous pulmonary fibrosis lesions requiring oxygen therapy at home, hospitalized almost every month in the past two years in cardiology, internal me-dicine, pneumology due to cardiac decompensation and relative treatment adherence, is again admitted in a particularly serious condition with generalized edema. Hemodynamic instability from admission required the establishment of positive inotropic support. The complex evaluation focuses on polyserosity with predomi-nant pleuro-pericardial development evolving on a di-abetic, atherosclerotic and systemic inflammatory field. Results: Under supportive treatment, clinical deve-lopment was slowly favorable with maintaining a sa-tisfactory quality of life and achieving the minimum necessary autonomy within a severe multidisciplinary pathology.
Conclusions: Severe heart failure is a challenge for cur-rent cardiovascular research. Treatment of co-morbi-dities associated with heart failure may limit the treat-ment of background disease. Drug-based medication reduces patient adherence. Heart failure is a significant economic burden for healthcare systems. Palliative care should be integrated into complex cardiac insufficien-cy management, also supported by current guidelines (ESC Guide 2016).