Palliative care in cardiology: knowing our patients’ values and responding to their needs

### Learning objectives Cardiovascular disease remains a leading cause of death internationally despite decades of advances in medical, surgical and device therapy. Our armament of treatments may support heart function, correct valvular dysfunction, ameliorate arrhythmias and delay death while improving functional status. However, none of these treatments are curative, and each carries at least a small risk of unintended negative consequences, including causing or prolonging suffering. Cardiovascular disease manifests in a variety of clinical profiles, ranging from a previously healthy person with an acute myocardial infarction to a middle-aged individual with an inflammatory cardiomyopathy to a teen with a Fontan repair of single ventricle disease. Their disease experiences and deaths may look very different from one another, but they can all benefit from the incorporation of palliative care. This article provides a description of palliative care as it applies to cardiology, including tools to facilitate the use of primary palliative care by cardiovascular clinicians. Palliative care is a specialised type of medical care that focuses on improving communication about goals of care (GOC), maximising quality of life and reducing symptoms.1 2 It is patient-centred and family centred care that is appropriate at any age and at any stage of a serious illness. In the past, it was often used synonymously with hospice, particularly in end-stage cancer, and gained a reputation as ‘doing nothing’ or ‘giving up’. However, palliative care is better seen as an ‘interventional’ specialty because of its focus on GOC that frame the appropriateness of therapies and its use of measures to ameliorate suffering. Palliative care should be applied alongside usual care in acute and chronic …