[2018] 89. Review the benefits and potential harms of a cardioverter defibrillator remaining active in a person with heart failure: at each 6-monthly review of their heart failure care whenever their care goals change as part of advance care planning if it is thought they are nearing the end of life. [2018] Chronic Heart Failure Guideline summary NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 90. Do not use prognostic risk tools to determine whether to refer a person with heart failure to palliative care services. [2018] 91. If the symptoms of a person with heart failure are worsening despite optimal specialist treatment, discuss their palliative care needs with the specialist heart failure MDT and consider a needs assessment for palliative care. [2018] 92. People with heart failure and their families or carers should have access to professionals with palliative care skills within the heart failure team. [2003] 1.2 Diagnostic algorithm Figure 1: Diagnostic algorithm Chronic Heart Failure Guideline summary NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 1.3 Therapeutic algorithm Figure 2: Therapeutic algorithm 1.4 Key research recommendations Heart Failure diagnosed by the specialist If symptoms persist despite optimal first line therapy, seek specialist advice and consider one or more of the following options Manage co-morbidconditions such as high blood pressure, atrial fibrillation ischaemic heart disease, and diabetes mellitus in line with NICE guidance 1 Please refer to CG180 for recommendations on the use of digoxin in patients with atrial fibrillation. For more information on drug treatment and monitoring see the NICE guideline on Chronic Heart Failure: assessment and management (CGX). Please refer to the NICE guidelines on chronic kidney disease (CG182) and on acute kidney injury (CG169). 