Palliative Care in Patients with Advanced Heart Failure: An Integrative Review

Abstract

The term advanced heart failure (HF) defines a profile of patients with severe symptoms, recurrent decompensations, and cardiac dysfunction despite optimized therapy. The clinical course of advanced HF is difficult to predict, and identifying the appropriate moment for integrating palliative care (PC) remains a challenge. To conduct an integrative review on the incorporation of palliative care in patients with advanced HF, highlighting the main differences in quality-of-life outcomes based on the most recent clinical studies. The topic was defined and the guiding question formulated according to the PICO model. A systematic search was performed for studies in Portuguese, Spanish, and English in the PubMed, LILACS, and SciELO databases, published in the last five years. The descriptors used were “heart failure,” “palliative care,” and “elderly patient.” A total of 54 articles were identified; after applying the inclusion and exclusion criteria, 9 studies were selected. Patients with advanced HF present a high symptom burden (pain, dyspnea, fatigue, anxiety, and depression). Early introduction of PC, ideally at critical points in the disease trajectory, enables symptom relief, reduced hospitalizations, and improved communication between families and healthcare teams. Early integration of palliative care should be understood as an essential strategy in the management of advanced heart failure. We emphasize the substantial gap that persists in the early introduction of palliative care in advanced HF, which requires coordinated, multidisciplinary action. It is essential that healthcare teams and public policies recognize PC as a fundamental and humanized component of advanced HF treatment, ensuring maximum comfort, dignity, and well-being for patients.