Description

Advances in the treatment of heart failure mean that more patients will be surviving to old age and, therefore, doctors involved in caring for elderly people need to be acquainted with the problems and issues facing these patients and their relatives as the disease progresses to its terminal stages. At an early stage patients and relatives need to be informed about the likely course and prognosis and discussion should take place about important issues such as advance directives and continuing power of attorney. Patients should be on the maximum tolerated doses of heart failure medication and precipitating factors must be excluded when symptoms persist or recur before attributing them to progression of the disease. Doctors need to focus more on symptom control and quality of life in end-stage heart failure rather than pursuing aggressive treatment with unnecessary hospital admission. The palliative care approach should be adopted more readily for this terminal disease and there should be close liaison with specialists in palliative care. Specialist heart failure nurses are likely to have a key role in co-ordinating the care of these patients.