The 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America guideline supports earlier integration of palliative care in heart failure and emphasizes that it should not depend solely on prognosis.

The guideline recommends that all patients with heart failure receive palliative and supportive care to improve quality of life, reduce symptom burden, enhance communication, and support decision-making. It specifically suggests referral to specialty palliative care for patients with advanced heart failure, uncontrolled symptoms, frailty, multimorbidity, or cognitive impairment.

The emphasis is on a needs-based approach rather than waiting until someone is clearly near the end of life. Early palliative care can help with dyspnea, fatigue, anxiety, depression, caregiver stress, advance care planning, and repeated hospitalizations. Studies such as the PAL-HF trial showed improvements in quality of life, anxiety, depression, and spiritual well-being when palliative care was introduced earlier alongside standard heart failure care (Rogers et al., 2017, pp. 331–341).

The guideline also distinguishes between “primary” palliative care, which all heart failure clinicians should provide, and “specialty” palliative care for more complex cases. In other words, palliative care is meant to run alongside disease-directed treatment, not replace it.

References
Rogers, J. G., Patel, C. B., Mentz, R. J., Granger, B. B., Steinhauser, K. E., Fiuzat, M., Adams, P. A., Speck, A., Johnson, K. S., Krishnamoorthy, A., Yang, H., Anstrom, K. J., Dodson, G. C., Jr, D. H., Kirchner, J. L., Mark, D. B., O’Connor, C. M. & Tulsky, J. A. (2017). Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial. Journal of the American College of Cardiology 70(3), pp. 331-341. https://doi.org/10.1016/j.jacc.2017.05.035