Role of Palliative Care in the Outpatient Management of the Chronic Heart Failure Patient

  • Sarah Chuzi
  • Esther S. Pak
  • Akshay S. Desai
  • Kristen G. Schaefer
  • Haider J. WarraichEmail author
Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (A Hasan, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise


Purpose of Review

Patients with heart failure (HF) have an increased symptom burden and complex psychosocial and decision-making needs that necessitate the integration of palliative care. However, in the current era, palliative care is frequently evoked for these patients only at the end-of-life or in the inpatient setting; rarely is palliative care proactively utilized in outpatients with HF. The purpose of this review is to evaluate the current state of palliative care and heart failure and to provide a roadmap for the integration of palliative care into outpatient HF care.

Recent Findings

Recent studies, including PAL-HF, CASA, and SWAP-HF, have demonstrated that structured palliative care interventions may improve quality of life, depression, anxiety, understanding of prognosis, and well-being in HF.


HF is associated with high mortality risk, significant symptom burden, and impaired quality of life. Palliative care can meet many of these needs; however, in the current era, palliative care consultations in HF occur late in the disease course and too often in the inpatient setting. Primary palliative care should be provided to all outpatients with heart failure based on their needs, with referral to secondary palliative care provided based on certain triggers and milestones.


Heart failure Palliative care Outpatient Clinic Symptoms 


Compliance with Ethical Standards

Conflicts of Interest

Dr. Desai reports personal fees from Abbott, grants and personal fees from Alnylam, grants and personal fees from AstraZeneca, personal fees from Boston Scientific, personal fees from Boehringer Ingelheim, grants and personal fees from Biofourmis, personal fees from DalCor Pharma, grants and personal fees from Novartis, personal fees from Relypsa, and personal fees from Regeneron, outside the submitted work.

Human and Animal rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  • Sarah Chuzi
    • 1
  • Esther S. Pak
    • 2
  • Akshay S. Desai
    • 3
    • 4
  • Kristen G. Schaefer
    • 4
    • 5
    • 6
  • Haider J. Warraich
    • 3
    • 4
    • 7
    Email author
  1. 1.Division of Cardiology, Department of MedicineNorthwestern University at Feinberg School of MedicineChicagoUSA
  2. 2.Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Center for Advanced Heart Disease, Division of Cardiovascular Medicine, Department of MedicineBrigham and Women’s HospitalBostonUSA
  4. 4.Harvard Medical SchoolBostonUSA
  5. 5.Department of Psychosocial Oncology and Palliative CareDana Farber Cancer InstituteBostonUSA
  6. 6.Division of Palliative MedicineBrigham and Women’s HospitalBostonUSA
  7. 7.Cardiology Section, Department of MedicineBoston VA Healthcare SystemBostonUSA

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