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Heart failure - chronic - Management
How should I manage someone with end-stage heart failure?
- Where palliative care for people with heart failure is similar to that for people with cancer, this overview provides links to CKS topics on the management of specific aspects of palliative care in people with cancer. More specific advice relating to people with heart failure can be found in such sources as the Merseyside and Cheshire Specialist Palliative Care and Cardiac Clinical Networks (see www.mccn.nhs.uk (pdf)).
- Optimizing treatment
- Seek specialist opinion to ensure that all relevant treatment options (including drugs and devices) have been considered and optimized. Because the symptoms of heart failure tend to fluctuate, it can be difficult to assess when people are in end-stage heart failure.
- Coordination of care services
- People with end-stage heart failure may require coordination of a diverse range of health and social care services to enable them to continue living at home and to die there if that is their wish. These services include primary care, community nursing, domiciliary care, social care, community pharmacy, occupational therapy, physiotherapy, dietetics, out-of-hours services, and hospice.
- Managing symptoms
- Breathlessness
- Optimize standard treatment with diuretics, fluid restriction (to between 1.5 L and 2 L daily), and avoidance of excessive consumption of salt. If this is ineffective, consider prescribing an opioid, a benzodiazepine, or oxygen.
- For information on when and how to prescribe opioids, benzodiazepines, and oxygen, see the CKS topic on Palliative cancer care - dyspnoea.
- Pain
- Anxiety, insomnia, and depression can be managed with sedatives and hypnotics.
- Constipation, nausea, and loss of appetite can be managed with dietary changes and laxatives.
- Urinary incontinence is often related to weakness and the use of diuretics. It can be managed by careful timing of diuretic doses; use of incontinence pads; and insertion of a urethral catheter, or for men, a urisheath.
- Managing an acute exacerbation of heart failure
- Admission to hospice or hospital is an option that should (ideally) be preplanned and reevaluated as the person's condition develops.
- Assess for and treat any exacerbating factors.
- Managing the terminal phase
- Explore the person's understanding; provide appropriate explanation of the situation to the person and their family and carers.
- Set realistic goals.
- Ensure that religious and spiritual care is offered if wanted.
- Ensure that the environment and care setting are appropriate. Consider involving occupational therapy to meet equipment needs and palliative care services.
- Stop unnecessary drugs and devices (such as implantable cardioverter-defibrillators). Continue necessary drugs by an appropriate route.
- Ensure that physical and emotional symptoms are well controlled.
- For more information, see the CKS topic on Palliative cancer care - general issues.
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