Improving end-of-life care in the cardiac intensive care unit: Navigating the challenge of timing palliative care intervention.

BACKGROUND: Integrating end-of-life (EoL) care in cardiac intensive care units (CICUs) is particularly complex because it requires a shift from a purely curative approach to one that emphasizes symptom management, emotional and spiritual support and patient-centered care. Moreover, this transition is challenging due to the need to balance life-sustaining treatments with the goals of comfort and dignity. The concept of EoL care varies across countries and is influenced by cultural, ethical and legal factors. METHODS: This narrative review examines palliative and EoL care in critically ill cardiac patients, including those with advanced heart failure, cardiogenic shock and other acute or chronic cardiac conditions, with a focus on models of care, multidisciplinary team involvement, ethical challenges and barriers to implementation in the CICU setting. RESULTS: Key candidates for palliative care (PC) in heart disease include patients with advanced heart failure, cardiogenic shock and other acute or chronic cardiac conditions; however, its implementation remains limited compared to other disciplines, such as oncology. In EoL care, multidisciplinary teams, including cardiologists, nurses, PC specialists and social workers, play a crucial role in providing holistic care. Effective communication with patients and their families is essential for aligning treatment with individual values and goals. Ethical dilemmas, such as the withdrawal of life-sustaining treatments and the deactivation of implanted cardiac devices, require compassionate and transparent decision-making. Unlike previous reviews, this work specifically highlights the timing of palliative care integration as the main factor influencing patient outcomes and family experience. CONCLUSIONS: Timely integration of palliative care in the CICU remains a major challenge. Significant gaps persist in training, resource allocation and quality indicators for palliative and EoL care. Addressing these shortcomings through enhanced education, standardized protocols and rigorous research is essential to ensure the effective delivery of PC in the CICU setting.