In this section new evidence was reviewed on the use of diuretics, domiciliary oxygen therapy and criteria for discussing ICD deactivation in patients with advanced heart failure, and the use of validated risk tools to identlfy patients with an increased risk of mortality. 10.1 Diuretics in advanced heart failure The use of diuretics is undoubtedly helpful in cases of systemic fluid overload or pulmonary congestion, and remain the only group of medication where there is consensus about its benefit in relieving the breathlessness in patients who have heart failure with preserved left ventricular ejection fraction (HFPEF). An important question arises in patients with advanced heart failure receiving palliative care in the community, is which route of administration of diuretics is most clinically and cost effective? 10.1.2 Review question: Which route of administration of diuretics (intravenous (IV), subcutaneous or oral) is most clinically and cost effective in people with advanced heart failure who are in the community, including patients receiving palliative care? For full details see review protocol in appendix A. Table 141: PICO characteristics of review question Population Advanced heart failure in the community Interventions / comparators IV diuretics (furosemide or torsemide) (continuous or bolus) + oral metolazone/thiazides IV diuretics (furosemide or torsemide) (continuous or bolus) alone Subcutaneous diuretics (furosemide or torsemide) +/- oral metolazone/thiazides Oral diuretics (bumetanide or furosomide and/or metolazone/thiazides). All compared to each other Thiazides are limited to: Bendroflumethiazide (Bendrofluazide) Cyclopenthiazide Chlorthalidone / Chlortalidone Indapamide Xipamide Metolazone Outcomes CRITICAL Quality of life Unplanned hospitalization Chronic Heart Failure Domiciliary oxygen therapy in people with advanced heart failure NICE 2018. All rights reserved. Subject to Notice of rights. 