At any stage of the disease, patients with heart failure have poorer quality of life than the general population.1,2 They also have a significant symptom burden which worsens as the disease progresses.3
Current European Society of Cardiology (ESC) heart failure guidelines regcognise the need for supportive and palliative care services for patients with end-stage heart failure.4 Integrated working between primary care, heart failure services and specialist palliative care (SPC) is essential.
Palliative care interventions from a multidisciplinary team (MDT) improve quality of life for patients with severe heart failure compared to those receiving standard care (n=150, 34% with severe left ventricular systolic dysfunction [LVSD], average NTproBNP ~13,000 pg/mL).5
However, a palliative approach to care and access to SPC services is patchy both nationally and internationally.
Barriers to effective palliative care include:
- unpredictable disease trajectory
- poor communication between members of the MDT – for example, a lack of clarity about the appropriate ceiling of medical therapy
- doctors may be reluctant to have the difficult conversations around the end of life due to concerns about destroying hope
- healthcare services are poorly set up for timely and effective palliative interventions.