David C Currow
Patricia M Davidson
Peter S Macdonald
Phillip J Newton
Chronic heart failure is common, particularly in older
individuals, and comorbidities are frequent. Patients with
end stage heart failure can be highly symptomatic and
require careful monitoring and treatment adjustment to
This article summarises the fundamentals of implementing
palliative care in general practice and provides guidelines on
caring for chronic heart failure patients at the end of life.
The high mortality in chronic heart failure underscores
the importance of effective communication, symptom
management and advanced care planning. The
unpredictability and uncertainty around the timing of death
mean that individuals, and their families, may be less likely
to have an understanding of their prognosis or have access
to supportive and palliative care. Ideally, patients with
symptomatic chronic heart failure should be managed in
collaboration with a multidisciplinary heart failure program.
Symptom management can be achieved by additive
therapies and access to specialist palliative care services
should be considered when the symptom burden is high.
Chronic heart failure (CHF) is common, and more than half of patients diagnosed with CHF will die within 5 years.1,2 Medical advances, particularly beta blocker therapy and implantable cardiac defibrillators,3 mean that many individuals with CHF are living longer and cared for in the community. Patients with CHF experience a wide range of frequently distressing symptoms and in addition to breathlessness, pain, nausea and constipation, low mood is common and generally poorly controlled.1,4–6 The symptom burden is of similar severity to patients with cancer,7 therefore integrating supportive care into CHF treatment is important in both primary and secondary care settings.
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