Evaluating Palliative Pharmacological Management for Symptom Control in Advanced Heart Failure

Patients with advanced heart failure (New York Heart Association Class III–IV) frequently experience distressing symptoms including breathlessness, fluid overload, anxiety, and pain. Although national and international guidelines advocate for the use of palliative medications to manage these symptoms, their use remains inconsistent particularly opioids and anxiolytics. This audit aimed to evaluate current prescribing practices for symptom relief in this population and identify areas for clinical improvement.

A retrospective audit was conducted on 35 patients with NYHA Class III–IV heart failure who were admitted to a hospital ward over a six-month period. Medical records were reviewed to determine whether symptoms were documented and appropriately managed with palliative medications. The audit measured compliance with established standards: opioids should be prescribed in at least 90% of patients with refractory breathlessness, anxiolytics in 90% of patients with documented anxiety, diuretics should be reviewed or adjusted in 100% of cases with fluid overload, and analgesia should be provided in 100% of patients with ongoing pain.

The audit found that opioids were prescribed in 85% of cases where patients experienced breathlessness. Anxiolytics were used in only 60% of patients with documented anxiety. Diuretics were appropriately reviewed or adjusted in all patients presenting with fluid overload. Analgesia was prescribed in 100% of cases where pain was reported.

The findings indicate strong compliance with diuretic and pain management standards but a notable underuse of opioids and anxiolytics, despite clinical indications. These results suggest a need for increased education and confidence in palliative prescribing for heart failure. Planned interventions include staff training and the introduction of a structured symptom assessment tool. A re-audit is scheduled in six months to evaluate the effectiveness of these changes.