Palliative Care in Advanced Heart Failure
Summary
Advanced heart failure is characterised by refractory symptoms, frequent hospitalisations and a trajectory that is often unpredictable. Patients experience a high burden of breathlessness, fatigue, pain and psychosocial distress, alongside complex comorbidities such as renal impairment and frailty. Traditional models of care have emphasised prognostic estimates to trigger palliative involvement, but this approach risks late or inequitable access. Contemporary practice instead advocates for needs-based assessment throughout the disease course, integrating symptom management, advance care planning and psychosocial support into routine cardiology follow-up. Multidisciplinary collaboration between heart failure teams, specialist palliative care and primary care is essential to address physical symptoms, emotional and spiritual distress, and to facilitate shared decision-making. Early incorporation of palliative principles—such as setting individualised goals of care, rationalising polypharmacy and supporting caregivers—has been shown to improve quality of life, reduce unplanned admissions and align treatment with patient preferences. Globally, health systems are developing referral pathways, training programmes and communication tools to ensure timely access to palliative expertise and to overcome barriers related to prognostic uncertainty, professional culture and resource limitations.
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Palliative Care in Advanced Heart Failure publication trend
The graph below shows the total number of articles in palliative care in advanced heart failure across all publications each year (not limited to Nature Index journals).
Technical terms
Palliative Performance Scale (PPS): A clinician-rated tool that measures functional status in palliative patients, combining mobility, intake, self-care and level of consciousness.
Kansas City Cardiomyopathy Questionnaire (KCCQ): A patient-reported outcome measure assessing physical limitation, symptoms, self-efficacy and quality of life in heart failure.
Dyspnoea: The subjective sensation of breathlessness or difficulty in breathing, a hallmark symptom of advanced heart failure.
Advance Care Planning (ACP): A process of discussion and documentation of future care preferences, including goals of care and end-of-life wishes.
Specialist Palliative Care (SPC): A multidisciplinary service providing expert assessment and management of complex symptoms, psychosocial support and care coordination.
References
- Facilitating Needs-Based Support and Palliative Care for People With Chronic Heart Failure: Preliminary Evidence for the Acceptability, Inter-Rater Reliability, and Validity of a Needs Assessment Tool. Journal of Pain and Symptom Management (2012).
- Characteristics and Trends Among Patients With Cardiovascular Disease Referred to Palliative Care. JAMA Network Open (2019).
- A Comparison of Hospitalized Patients With Heart Failure and Cancer Referred to Palliative Care. JAMA Network Open (2020).
- Criteria for Referral of Patients With Advanced Heart Failure for Specialized Palliative Care. Journal of the American College of Cardiology (2022).
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