Mrs Doherty has a complex medical history including heart disease, renal impairment, hypertension and diabetes. She has a history of stroke, the most recent one being two years ago. She now has severely impaired systolic function as a result of a recent myocardial infarction (8 months ago) and is short of breath and fatigued. Her legs are uncomfortable due to moderate peripheral oedema. She has been told by her cardiologist that her heart failure can only be treated with medications and has been difficult to control due to her concurrent renal impairment.