Optimally treat heart failure and co-morbidities
Assess and manage anxiety / depression
Consider referral for cardiac rehabilitation
Suggest use of hand fan on exertion
FAB (fatigue, anxiety, breathlessness) or similar symptom management programme
Consider slow-release Morphine 5mg-10mg BD & titrate to response (in normal renal function)
For further non-pharmacological and pharmacological management please
If renal impairment is present, take into account when prescribing analgesia.
Consider reversible causes – constipation, blood glucose control, dry mouth, digoxin toxicity.
Consider if gut oedema is affecting absorption of oral agents and if non-oral route may be more effective.
In heart failure, cyclizine is generally avoided due to its antimuscarinic effect.
Constipation is a common and troublesome symptom in advanced heart failure. It can exacerbate other symptoms such as fatigue and breathlessness.
1st line: Stimulant (e.g. senna, sodium picosulphate); provide routinely to patients on opioids.
2nd line: Softener ( e.g. sodium docusate, polyethylene glycol).
There is a high incidence of depression in patients with chronic illness. Specific tools are available to assess for this eg Hospital Anxiety and Depression Scale (HADS)
Consider referral to appropriate psychological services
If antidepressants are indicated:
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.