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Palliative Care in End-stage HF — EECC MCQ

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ModerateHeart FailurePalliative Care in End-stage HFEECC

A 75-year-old man with end-stage HFrEF (LVEF 15%), NYHA class IV despite maximal GDMT, recurrent hospitalisations, and severe frailty (Clinical Frailty Score 7) is not a candidate for transplantation or mechanical circulatory support. He expresses a wish for comfort-focused care. What is the most appropriate palliative intervention for his refractory breathlessness?

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Correct answer: D — Low-dose oral morphine (1-2.5 mg every 4 hours as needed) with review of diuretic therapy

In end-stage HF with refractory symptoms where active treatment escalation is no longer appropriate, palliative care should focus on symptom management. Low-dose opioids (morphine 1-2.5 mg orally) are effective for refractory breathlessness and improve quality of life without hastening death when used appropriately. The ESC HF Guidelines (2023) recommend integrating palliative care early in the HF trajectory (recommended). Diuretics should be continued for congestion relief. Medications that improve symptoms (diuretics, nitrates) should be maintained; those primarily for prognosis (beta-blocker, ACEi) may be cautiously reduced if causing side effects. GDMT should not be abruptly withdrawn.

Reference: NICE NG106: Chronic heart failure in adults—diagnosis and management: https://www.nice.org.uk/guidance/ng106/chapter/recommendations