Palliative Care for Symptomatic Heart Failure: A New Paradigm

Published:December 13, 2022DOI:


      • More patients are hospitalized for heart failure than from all cancers combined.
      • About 50% of patients diagnosed with heart failure die within 5 years.
      • There is a paradigm shift to implement palliative care sooner in heart failure care.
      • Palliative care for heart failure improves symptom management and quality of life.


      The nation’s largest, fastest growing, and costliest patient population are those living with symptomatic heart failure (HF). Patients with HF live, on average, for 5 years. Preventing the escalation of symptoms or an exacerbation is key when optimizing patient quality of life. Earlier integration of palliative symptom management can reduce exacerbation, prevent debility, maintain physical functioning, improve costly hospitalization, and improve patient quality of life. The current trends in policy and practice provide an important paradigm for the nurse practitioner when effectively managing the patient with HF.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • World Heart Federation
        Roadmap for heart failure: informing health systems approaches to heart failure by prioritizing practical, proven, cost-effective action.
        • Ferreira J.P.
        • Kraus S.
        • Mitchell S.
        • et al.
        World Health Federation roadmap for heart failure.
        Global Heart. 2019; 14: 197-214
        • Centers for Disease Control and Prevention
        Heart failure.
        (Updated September 8)
        Date: 2020
        Date accessed: May 8, 2022
        • Gangavelli A.
        • Morris A.
        Premature cardiovascular mortality in the United States: who will protect the most vulnerable among us?.
        Circulation. 2021; 144: 1280-1283
        • Vecchione A.
        Annual heart failure costs in the US could surpass $70B by 2030.
        (January 25)
        • National Heart Lung and Blood Institute
        What is heart failure? Updated March 24.
        Date: 2022
        Date accessed: March 30, 2022
        • QuickStats
        Age-adjusted death rates from heart disease among adults aged 45–64 years by urbanization level and sex. National Vital Statistics System, United States, 2019.
        MMWR Morb Mortal Wkly Rep. 2021; 70: 1621
        • Patel J.
        Heart failure population health considerations.
        Am J Manag Care. 2022; 27: S191-S195
        • Ibrahim N.
        Guideline updates in heart failure: expert breakdown of key takeaways.
        (May 17)
        Date: 2022
        Date accessed: May 18, 2022
      1. Mayo Clinic. Heart failure.
        • Heidenreich P.A.
        • Bozkurt B.
        • Aguilar D.
        • et al.
        2022 AHA/ACC/HFSA guidelines for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
        Circulation. 2022; 145: e895-e1032
        • World Health Organization
        Palliative care.
        Date: 2020
        Date accessed: May 8, 2022
        • World Health Organization
        Assessing the development of palliative care worldwide: a set of actionable indicators.
        Date: 2021
        Date accessed: May 10, 2022
        • Rosa W.E.
        • Buck H.G.
        • Squires A.P.
        • et al.
        American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.
        Nurs Outlook. 2021; 69: 961-968
        • National Academies of Sciences
        Engineering and Medicine. Integrating Serious Illness into Primary Care Delivery: Proceedings of a Workshop.
        The National Academies Press, 2022
        • Urbich M.
        • Globe G.
        • Pantiri K.
        • et al.
        A systematic review of medical costs associated with heart failure in the USA (2014–2020).
        Pharmacoeconomics. 2020; 38: 1219-1236
        • Wiskar K.
        • Toma M.
        • Rush B.
        Palliative care in heart failure.
        Trends Cardiovasc Med. 2018; 28: 445-450
        • von Schwarz E.
        • He M.
        • Bharadwaj P.
        Palliative care issues for patients with heart failure.
        JAMA Netw Open. 2020; 3e200011
        • Singh V.
        • Lin E.
        Congestive heart failure imaging.
        (Updated March 16, Medscape)
        Date: 2018
        Date accessed: May 10, 2022
        • Gibson G.
        • Blummer V.
        • Mentz R.
        • Lala A.
        Universal definition, and classification of heart failure: a step in the right direction. American College of Cardiology.
        • Woods M.
        • Kuebler K.
        Cardiovascular disease.
        in: Kuebler K. Integration of Palliative Care in Chronic Conditions: An Interdisciplinary Approach. Oncology Nursing Society, 2017: 125-140
        • Diop M.
        • Rudolph J.
        • Zimmerman K.
        • Richter M.
        • Skarf L.
        Palliative care interventions for patients with heart failure: a systematic review and meta-analysis.
        J Palliat Med. 2017; 20: 84-92
        • Tromp J.
        • Ouwerkerk W.
        • van Veldhuisen D.
        Systematic review and network meta-analysis of pharmacological treatment of heart failure with reduced ejection fraction.
        JACC Heart Fail. 2022; 10: 73-84
        • Food and Drug Administration
        FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning.
        (Updated January 19)


      Kim Kuebler, DNP, APRN, ANP-BC, FAAN, is the director/founder of the Multiple Chronic Conditions Resource Center, Duane L Waters Health Center, Michigan Department of Corrections, Jackson, MI. Dr Kuebler can be reached at [email protected]