The care of patients with severe cardiovascular disease and multimorbidity entails complex medical decision-making especially at the end of life. Proven therapies must be incorporated into the context of patient preferences, values, and goals to achieve effective titration of medications and appropriate initiation and withdrawal of cardiac device therapies. As patients decline in the terminal stages, it is important to modify medical and device therapies in accordance with goals and values, and with hemodynamic changes, increasing multimorbidity, and accumulating symptom burden. The provision of effective end of life care for those with cardiovascular disease and multimorbidity requires cooperation between palliative care, specialty care, and primary care.
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