March 19, 2025ESC Heart FailureOpen Access

Elements of Effective Palliative Care Interventions in Advanced Heart Failure: A Narrative Review

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Why the study?

Patients with advanced heart failure face significant biopsychosocial needs and poor prognosis, leading international guidelines to recommend integrating palliative care into heart failure management.

Do palliative care interventions improve health outcomes, quality of life, and symptoms in patients with advanced heart failure?

Structured PICO

Do palliative care interventions improve health outcomes, quality of life, and symptoms in patients with advanced heart failure?

Population

Patients with advanced heart failure (data synthesized from 21 papers across 18 clinical trials)

Intervention

Palliative care interventions (including interdisciplinary teams comprising primary care, cardiology, and palliative care; routine check-ins; personalized care plans; evidence-based symptom management; and counselling)

Comparator

Usual care

Outcome

Health outcomes, quality of life, and functional and symptomatic improvementspatient reported

Integrating interdisciplinary palliative care with heart failure management can improve quality of life and symptoms for patients with advanced heart failure, supporting current international guidelines.

Implication

Mixed results leave open palliative care benefits in advanced HF; hypothesis-generating and requires RCTs before practice change.

Abstract

People with advanced heart failure experience significant biopsychosocial needs and have a poor prognosis. International guidelines have called for integrating palliative care in heart failure management. This review explores the elements of effective palliative care interventions in advanced heart failure. PubMed, Embase, CINAHL and Cochrane Reviews were searched following an a priori review protocol for clinical trials of advanced heart failure and palliative care. The risk of bias was assessed using Risk of Bias 2 (RoB2). A qualitative, emergent approach was used to synthesize context + mechanism = outcome. Twenty-one papers from 18 studies were the data source. The efficacy of palliative care in advanced heart failure was mixed. Five studies reported significant improvement in health outcomes compared with the usual care control group. Timing may be necessary in accounting for improvement in quality of life (occurring on or about 3 months) and functional and symptomatic improvements (occurring on or about 6 months or longer). Effective models of secondary palliative care in advanced heart failure include interdisciplinary teams comprising primary care, cardiology and palliative care, routine check-ins, personalized care plans that explore goals, evidence-based symptom management and counselling. Integrating palliative care with heart failure management could improve patient outcomes. Future research and policy development may wish to consider when, how and what palliative care modalities are to be incorporated into the care of patients with advanced heart failure.