Implementation of Embedded Specialty Palliative Care in an Advanced Heart Failure and Transplant Clinic

Advanced heart failure (HF) is characterized by high morbidity and mortality, yet palliative care is frequently delayed or underutilized. While prior studies support earlier use of palliative services, outpatient models incorporating structured goals-of-care discussions within advanced HF and transplant evaluation remain limited. We describe a clinician-led, embedded approach within a multidisciplinary HF clinic at a tertiary care center, in which HF providers trained in serious illness communication conduct advance care planning as part of routine evaluation for transplant and left ventricular assist device (LVAD) candidacy. Since implementation in January 2023, three HF clinicians have completed formal communication training, and approximately 324 patients have been evaluated using this model. Documentation of serious illness discussions and advance care planning occurred in all eligible patients, with medical decision-making preferences addressed at each visit and caregiver involvement encouraged when appropriate. By integrating these discussions into existing clinical workflows, this model supports timely, continuous, and disease-specific communication without reliance on external referral. In conclusion, embedding palliative care within advanced HF teams is a practical and scalable strategy that may improve alignment of care with patient goals during complex treatment decision-making.