A collaborative cardiology and palliative care approach should be considered for all patients with heart failure who continue to have symptoms despite optimally tolerated heart failure therapy.
This should include a review of the patient’s symptoms, clinical assessment including fluid balance, assessment of biochemistry and review of medications prescribed for symptom management and for prognostic benefit.
Nonessential medications or those where side effects are problematic should be stopped.
Patients with defibrillators (ICD or CRT-D) should have regular review to ensure that device activation remains appropriate.
Where a defibrillator is to be deactivated this is best done in a controlled setting but can be done acutely if necessary.
Pacemakers or cardiac resynchronisation systems with a pacemaker only (CRT-P) can remain active and will not cause pain or prolong life.
All patients should have a holistic assessment with a clear management plan and where appropriate an anticipatory care plan developed and communicated to all members of the multidisciplinary team.
This plan should clearly state the priorities of care including resuscitation status and preferred place of care.
Out patients who are felt to be in a palliative category should be placed on the palliative care register.
The HFLN is integral to facilitation of the management plans, establishing priorities of care and coordination of care.
“Treatment of the very frail should be guided by individual circumstances and co morbidities and need not follow guideline recommendations”