BMJ 1994;308:717 (12 March)

Letters

Palliative care in severe heart failure

EDITOR, - I wish to draw attention to Henry J Dargie and J J V McMurray's comments about the malignant nature of severe heart failure,1 and the need for discussion about quality rather than quantity of life in this condition. Palliative medicine is the "study and management of patients with active, progressive, far-advanced disease for whom the prognosis is limited and the focus for care is quality of life."2 It addresses not the diagnosis but the need for care in the final stages of life. Patients with cancer are not the only patients with this need.

Palliative medicine has revolutionised the management of pain and other symptoms of cancer, including dyspnoea. End stage heart failure has several features in common with cancer, such as dyspnoea, tiredness, and cachexia. The role of opioids in acute pulmonary oedema is undisputed. Little information exists, however, on the effects of oral or nebulised morphine . . . [Full text of this article]


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Relevant Article

Fortnightly Review: Diagnosis and management of heart failure
H J Dargie and J J V McMurray
BMJ 1994 308: 321-328. [Abstract] [Full Text]

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