Clinician‐Initiated Palliative Care Referral Versus Advanced Heart Failure Referral Criteria in Hospitalized Patients With Heart Failure: A Retrospective Study

Aim The overall aim was to examine clinician‐initiated palliative care referral practices in relation to referrals indicated by the advanced heart failure (AHF) referral criteria among hospitalized patients with heart failure. Design: A retrospective observational study. Methods Medical records of 450 adults hospitalized with heart failure during 2023–2024 were reviewed. Clinician‐initiated palliative care referral was compared with AHF referral criteria. Firth logistic regression examined referral‐associated factors. Six‐month mortality from the index admission was a pragmatic prognostic endpoint, not a measure of palliative care needs. Results Among 450 patients, clinician‐initiated palliative care referral was uncommon, and most patients meeting the advanced heart failure referral criteria were not referred. Agreement between the two approaches was low. Metastatic cancer and New York Heart Association functional class were associated with referral in the adjusted model. The referral criteria showed greater sensitivity for six‐month mortality, whereas clinician‐initiated referral showed greater specificity. Conclusion Clinician‐initiated referral and the AHF referral criteria identified different proportions of hospitalized patients with heart failure. Their differing performance for six‐month mortality supports further prospective evaluation; clinical utility for identifying palliative care needs remains unestablished. Implications for the Profession and/or Patient Care The findings identify an opportunity for nurses and multidisciplinary teams to assess needs among criteria‐positive patients without specialist referral. Whether screening improves care requires prospective evaluation. Impact The study documents differences between clinician‐initiated referral and AHF referral criteria in a broader hospitalized heart failure population. It provides a basis for evaluating systematic needs assessment alongside existing referral practices. Reporting Method Reporting followed the RECORD extension of the STROBE statement. Patient or Public Contribution This study did not include patient or public involvement in its design, conduct, or reporting.