title: End stage heart failure patients - palliative care in general practice.
abstract: BACKGROUND
  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 improve symptoms.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: St Vincent's & Mater Health, Curtin Health Innovation Research Institute, Curtin University, Sydney, New South Wales. p.davidson@curtin.edu.au
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
authors.forename: Peter S
authors.initials: PS
authors.lastname: Macdonald
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Newton
authors.forename: David C
authors.initials: DC
authors.lastname: Currow
mesh_terms: D001315:Australia; D058006:General Practice; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D019452:Terminally Ill