Intended for healthcare professionals

Clinical Review State of the Art Review

Palliative care in patients with heart failure

BMJ 2016; 353 doi: (Published 14 April 2016) Cite this as: BMJ 2016;353:i1010
  1. Colleen K McIlvennan, assistant professor of medicine1 2 3,
  2. Larry A Allen, associate professor of medicine1 2 3
  1. 1Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
  2. 2Adult and Child Center for Health Outcomes and Research and Delivery Sciences, University of Colorado School of Medicine, Aurora, CO, USA
  3. 3Colorado Cardiovascular Outcomes Research Consortium, Denver, CO, USA
  1. Correspondence to: L A Allen, School of Medicine, University of Colorado, B130 Aurora, CO 80045, USA larry.allen{at}


Despite advances in cardiac therapy, heart failure (HF) remains a progressive, highly symptomatic, and deadly disease that places great demands on patients, caregivers, and healthcare systems. Palliative care is a multidisciplinary approach to care that focuses on communication, shared decision making, and advance care planning; provides relief from pain and other distressing symptoms; integrates psychological and spiritual aspects of care; and offers a support system to help families cope during illness and bereavement. Palliative care has applications across the stages of heart failure, including early in the course of illness, often in conjunction with other therapies that are intended to prolong life. However, the incorporation of palliative care into the management of heart failure has been suboptimal for several reasons: uncertainty in the disease trajectory, failure to reward communication between healthcare providers and patients, siloed care, lack of knowledge, overlay of comorbidity and frailty, life saving devices with complex trade-offs, and a limited evidence base. This review will summarize the current literature on the emerging role of palliative care in patients with heart failure and the challenges and opportunities for its integration into routine care. It will discuss current initiatives and future directions of the collaborative relationship between the palliative care and heart failure disciplines.


  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: LAA discloses institutional research grant support from National Institutes of Health and Patient-Centered Outcomes Research Institute; and consulting relationships with St Jude, Janssen, and Novartis.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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