{"id":3767,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/cardiacdiseasepalliativecare\/"},"modified":"2025-06-02T16:09:46","modified_gmt":"2025-06-02T15:09:46","slug":"cardiacdiseasepalliativecare","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/palliativecare\/cardiacdiseasepalliativecare\/","title":{"rendered":"Cardiac Disease (Palliative Care)"},"content":{"rendered":"\n<p>The trajectory of heart failure is complex, with periods of stability followed by decompensation. Clinical expertise should be used alongside prognostic indicators to assist the clinician to consider a palliative care approach.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>This could involve placing your patient on the palliative care register with a view to changing the focus of care towards palliation of symptoms rather than prolonging life.<\/li>\n\n\n\n<li>Specialist&nbsp; advice is available to guide primary care management of &nbsp;patients with more complex needs from the cardiology CNS and specialist palliative care services<\/li>\n\n\n\n<li>Remember patients with devices such as Implantable Cardioverter Defibrillators (ICD&#8217;s) may need sensitive and timely discussions around deactivation of the device. Advice can be obtained from the Cardiology team about this process.<\/li>\n<\/ul>\n\n\n\n<p>Remember patients with devices such as Implantable Cardioverter Defibrillators (ICD\u2019s) may need sensitive and timely discussions around deactivation of the device. Advice can be obtained from the Cardiology team about this process. See <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/cardiology\/implantable-cardiac-devices\/\" target=\"_blank\" rel=\"noreferrer noopener\">Implantable Cardiac Devices \u2013 RefHelp (nhslothian.scot)<\/a><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Who to refer:<\/strong><\/p>\n\n\n\n<p>Patients who are expected to die from their condition within the next 12 months. Indications that this may be the case include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Repeated hospital admissions<\/li>\n\n\n\n<li>Continued symptoms despite optimal treatment<\/li>\n\n\n\n<li>Difficult physical or psychological symptoms despite optimal tolerated therapy<\/li>\n\n\n\n<li>Deteriorating renal function<\/li>\n\n\n\n<li>Evidence of hyponatraemia<\/li>\n\n\n\n<li>Progressive weight loss (Cachexia)<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients whose disease is stable<\/li>\n\n\n\n<li>Patients whose symptoms you are able to manage satisfactorily<\/li>\n\n\n\n<li>Patients where you would be surprised if they died in the next 12 months<\/li>\n\n\n\n<li>Patients who do not accept a palliative approach to their illness<\/li>\n\n\n\n<li>Patients who have expressed a wish to have no extra help.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>Referral details for the different Palliative Care services are available&nbsp;at<\/p>\n\n\n\n<p><a href=\"http:\/\/www.nhslothian.scot.nhs.uk\/Services\/A-Z\/PalliativeCare\/Pages\/SpecialistPalliativeCareServices.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">Palliative Care &#8211; Specialist Palliative Care<\/a><\/p>\n\n\n\n<p>For Heart failure treatment advice contact the Cardiology Team:&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/heartfailure\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/heartfailure\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/refhelp\/Cardiology\/HeartFailure<\/a><\/p>\n\n\n\n<p><a href=\"mailto:Heartfailure.nurseservice@nhslothian.scot.nhs.uk\" target=\"_blank\" rel=\"noreferrer noopener\">Heartfailure.nurseservice@nhslothian.scot.nhs.uk<\/a><\/p>\n\n\n\n<p>IMPACT An Edinburgh based Community (Edinburgh HSCP Only): Long term condition team, to improve patient care and reduce admissions<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/improvedanticipatorycareandtreatmentimpact\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/improvedanticipatorycareandtreatmentimpact\/\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/IMProvedAnticipatoryCareandTreatmentIMPACT.aspx<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Scottish palliative care guidelines on breathlessness:&nbsp;&nbsp;<\/strong><a href=\"https:\/\/www.palliativecareguidelines.scot.nhs.uk\/guidelines\/symptom-control\/breathlessness.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.palliativecareguidelines.scot.nhs.uk\/guidelines\/symptom-control\/breathlessness.aspx<\/a><\/p>\n\n\n\n<p><strong>Palliative care Kardex:&nbsp;&nbsp;<\/strong><a href=\"\/files\/sites\/2\/anticipatory-medication.pdf\" data-type=\"URL\" data-id=\"\/files\/sites\/2\/anticipatory-medication.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/ResourcesLinks\/anticipatory medication.pdf<\/a><\/p>\n\n\n\n<p>Hospital at home:&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/hospital-at-home\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/hospital-at-home\/\" target=\"_blank\" rel=\"noreferrer noopener\">Hospital at Home (nhslothian.scot)<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Chest, Heart and Stroke Scotland&nbsp;<a href=\"https:\/\/www.chss.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.chss.org.uk\/<\/a><\/p>\n\n\n\n<p>Voice of Carers Across Lothian&nbsp;<a rel=\"noreferrer noopener\" href=\"https:\/\/www.vocal.org.uk\/\" target=\"_blank\">https:\/\/www.vocal.org.uk\/<\/a><\/p>\n\n\n\n<p><a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/anticipatory-medication.pdf\" target=\"_blank\">anticipatory medication<\/a><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>SPICT. Future Care Planning REDMAP pocket guide <a href=\"https:\/\/www.spict.org.uk\/wp-content\/uploads\/2023\/10\/REDMAP-cards-for-staff-September-2023.pdf\">https:\/\/www.spict.org.uk\/wp-content\/uploads\/2023\/10\/REDMAP-cards-for-staff-September-2023.pdf<\/a><\/li>\n\n\n\n<li>Ihub. Future Care Planning Toolkit <a href=\"https:\/\/ihub.scot\/project-toolkits\/future-care-planning-toolkit\/future-care-planning-toolkit\/\">https:\/\/ihub.scot\/project-toolkits\/future-care-planning-toolkit\/future-care-planning-toolkit\/<\/a><\/li>\n\n\n\n<li>NHS Inform. Future Care Planning &#8211; <a href=\"https:\/\/www.nhsinform.scot\/care-support-and-rights\/decisions-about-care\/future-care-planning\/\">https:\/\/www.nhsinform.scot\/care-support-and-rights\/decisions-about-care\/future-care-planning\/<\/a><\/li>\n\n\n\n<li>TURAS Learn. Realistic Medicine &#8211; Having Realistic Conversations <a href=\"https:\/\/learn.nes.nhs.scot\/60442\">https:\/\/learn.nes.nhs.scot\/60442<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>The trajectory of heart failure is complex, with periods of stability followed by decompensation. Clinical expertise should be used alongside prognostic indicators to assist the clinician to consider a palliative care approach. Remember patients with devices such as Implantable Cardioverter Defibrillators (ICD&rsquo;s) may need sensitive and timely discussions around deactivation of the device. Advice can<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4283,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[534],"class_list":["post-3767","page","type-page","status-publish","hentry","category-cardiacdiseasepalliativecare"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/palliativecare\/cardiacdiseasepalliativecare\/\" rel=\"tag\">Cardiac Disease (Palliative Care)<\/a>","rttpg_excerpt":"The trajectory of heart failure is complex, with periods of stability followed by decompensation. Clinical expertise should be used alongside prognostic indicators to assist the clinician to consider a palliative care approach. Remember patients with devices such as Implantable Cardioverter Defibrillators (ICD&rsquo;s) may need sensitive and timely discussions around deactivation of the device. Advice can","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3767","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3767"}],"version-history":[{"count":9,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3767\/revisions"}],"predecessor-version":[{"id":24177,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3767\/revisions\/24177"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4283"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3767"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3767"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}