Palliative Care for People Living with Heart Failure

Heart failure (HF) is a clinical syndrome affecting approximately 5 million people worldwide, causing a significant symptom burden and reducing both quality of life and survival. It is a common end pathway of many cardiovascular and noncardiovascular diseases. Symptoms suffered by affected individuals can be caused directly or indirectly by hemodynamic alterations, the disease being the cause of heart injury, or a concomitant disease. The impairment of heart structure and function is usually progressive and, with optimal guidelines directed treatment, this can be slowed (sometimes for a long time) rather than reversed or stopped. Recent advances in the management of HF, most impressive in the case of HF with reduced ejection fraction (HFrEF), have significantly improved the quality of life and prognosis. Current therapies involve medical management and both electronic and mechanical cardiovascular-implantable devices, as well as heart transplantation.  Implementing palliative care (PC) principles (only sometimes requiring specialized PC) into routine cardiological care improves the quality of life of affected people more than providing cardiological care alone. The needs for PC and symptoms should be assessed regularly. The complexity of HF management requires close cooperation between cardio and PC teams, but a mutual understanding of the principles of both approaches is fundamental for optimal symptom management and support for those living with HF and their relatives, mostly in decision-making. The management of hallmark HF symptoms is more efficient if the improved circulatory pathophysiology is complemented by pure symptom-oriented interventions. Adjustment of cardiological therapies at the end of life and the modification of the activity of cardiovascular implantable devices can be challenging, but advance care planning and care for those who are dying can improve their quality of life, including during the dying phase, and increase satisfaction with care.