Palliative Care in Heart Failure: A Practical Approach

Chronic heart failure (HF) is a complex clinical syndrome and a major cause of morbidity and mortality, which affects more than 64 million people worldwide. HF is associated with decreased life expectancy and is characterised by increased hospitalisations, which increase in frequency and severity as the disease progresses. Patients with advanced HF experience a poorer health status and quality of life. Advanced HF increases the risk of premature death (80% of patients die within 5 years), as well as increasing symptoms, psychosocial and spiritual burden. The trajectory of the disease is unpredictable and person-specific, influenced by a multitude of factors including age of diagnosis, ethnicity, gender, comorbidity and socioeconomic status. In advanced HF, symptom management, psychosocial support and assistance with advanced care planning are important aspects of delivering holistic care. Dyspnoea, fatigue, pain, depression, anxiety, insomnia and worsening cognitive function are frequently seen in these patients. The symptoms experienced by the patient can be caused by the HF itself, comorbidities and treatment side effects, which all require careful consideration. While many aspects of palliative care are universal, HF patients have unique needs, challenges, and opportunities. Palliative care is much less likely to be offered to patients with HF than to those with other diagnoses. In this article, we explore the rationale for improving patient access and the key opportunities and challenges for delivering high-quality palliative care in this group.