In the dying phase, it will be appropriate to review and discontinue some of the patient’s medication (in consultation with the Cardiology or Specialist Palliative Care Team).
In general continue with medications with symptomatic benefits and stop those aimed at medium to long term reductions in morbidity and mortality.
Consider continuing with following as they may be providing symptomatic benefit:
- diuretics (unless too dehydrated, may be appropriate as CSCI)
- antianginal medication (consider transdermal nitrate if patient is not able to take oral medication
- digoxin (stopping digoxin may worsen heart failure due to the positive inotropic effects of digoxin)
Reassess the value of the following and consider stopping:
- lipid lowering drugs
- ACE inhibitors or ARBs
- antihypertensives (monitor BP initially)
- antiplatelet medication
- anti-anginal medication if no symptoms (monitor for symptom recurrence; consider transdermal nitrate if patient is no able to take oral medication)