{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:22:18Z","timestamp":1791332538292,"version":"4.3.1"},"reference-count":169,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:00:00Z","timestamp":1768694400000},"content-version":"vor","delay-in-days":1932,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2020,10,4]],"date-time":"2020-10-04T00:00:00Z","timestamp":1601769600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The Heart Failure Association of the European Society of Cardiology has published a previous position paper and various guidelines over the past decade recognizing the value of palliative care for those affected by this burdensome condition. Integrating palliative care into evidence-based heart failure management remains challenging for many professionals, as it includes the identification of palliative care needs, symptom control, adjustment of drug and device therapy, advance care planning, family and informal caregiver support, and trying to ensure a \u2018good death\u2019. This new position paper aims to provide day-to-day practical clinical guidance on these topics, supporting the coordinated provision of palliation strategies as goals of care fluctuate along the heart failure disease trajectory. The specific components of palliative care for symptom alleviation, spiritual and psychosocial support, and the appropriate modification of guideline-directed treatment protocols, including drug deprescription and device deactivation, are described for the chronic, crisis and terminal phases of heart failure.<\/jats:p>","DOI":"10.1002\/ejhf.1994","type":"journal-article","created":{"date-parts":[[2020,10,5]],"date-time":"2020-10-05T01:18:00Z","timestamp":1601860680000},"page":"2327-2339","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":174,"title":["Integration of a Palliative Approach into Heart Failure Care: A European Society of Cardiology Heart Failure Association Position Paper"],"prefix":"10.1093","volume":"22","author":[{"given":"Loreena","family":"Hill","sequence":"first","affiliation":[{"name":"School of Nursing and Midwifery, Queen\u2019s University , Belfast ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tal","family":"Prager Geller","sequence":"additional","affiliation":[{"name":"Palliative Care Ward at Dorot Health Centre, Heart Failure Unit at Rabin Medical Center , Netanya ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Resham","family":"Baruah","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster NHS Foundation Trust , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Beattie","sequence":"additional","affiliation":[{"name":"Cicely Saunders Institute, King\u2019s College London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josiane","family":"Boyne","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre , Maastricht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noemi","family":"de Stoutz","sequence":"additional","affiliation":[{"name":"ESC Patient Forum Representative , Bern ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Di Stolfo","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza , San Giovanni Rotondo ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekaterini","family":"Lambrinou","sequence":"additional","affiliation":[{"name":"Department of Nursing, Cyprus University of Technology , Limassol ,","place":["Cyprus"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne K.","family":"Skibelund","sequence":"additional","affiliation":[{"name":"ESC Patient Forum Representative , Bern ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izabella","family":"Uchmanowicz","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Wroclaw Medical University , Wroclaw ,","place":["Poland"]},{"name":"Centre for Heart Diseases, University Hospital , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frans H.","family":"Rutten","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelena","family":"\u010celutkien\u0117","sequence":"additional","affiliation":[{"name":"Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius ,","place":["Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo Francesco","family":"Piepoli","sequence":"additional","affiliation":[{"name":"Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital , Piacenza ,","place":["Italy"]},{"name":"University of Parma , Parma ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa A.","family":"Jankowska","sequence":"additional","affiliation":[{"name":"Centre for Heart Diseases, University Hospital , Wroclaw ,","place":["Poland"]},{"name":"Department of Heart Diseases, Wroclaw Medical University , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ovidiu","family":"Chioncel","sequence":"additional","affiliation":[{"name":"Emergency Institute for Cardiovascular Diseases \u2018Prof. C.C. Iliescu\u2019 , Bucharest ,","place":["Romania"]},{"name":"University of Medicine Carol Davila , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuvia","family":"Ben Gal","sequence":"additional","affiliation":[{"name":"Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petar M.","family":"Seferovic","sequence":"additional","affiliation":[{"name":"Cardiology Department, Clinical Centre Serbia, Medical School Belgrade , Belgrade ,","place":["Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Ruschitzka","sequence":"additional","affiliation":[{"name":"Clinic for Cardiology, University Hospital Zurich , Zurich ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.S.","family":"Coats","sequence":"additional","affiliation":[{"name":"IRCCS San Raffaele Pisana , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Str\u00f6mberg","sequence":"additional","affiliation":[{"name":"Department of Health, Medicine and Caring Sciences, Link\u00f6ping University , Link\u00f6ping ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiny","family":"Jaarsma","sequence":"additional","affiliation":[{"name":"Department of Health, Medicine and Caring Sciences, Link\u00f6ping University , Link\u00f6ping ,","place":["Sweden"]},{"name":"Julius Center, University Medical Center Utrecht , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,10,4]]},"reference":[{"key":"2026080800515715200_ejhf1994-bib-0001","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1002\/ejhf.1594","article-title":"Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis","volume":"21","author":"Jones","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2026080800515715200_ejhf1994-bib-0002","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/S1388-9842(02)00034-X","article-title":"Prevalence of chronic heart failure in Southwestern Europe: the EPICA study","volume":"4","author":"Ceia","year":"2002","journal-title":"Eur J Heart Fail"},{"key":"2026080800515715200_ejhf1994-bib-0003","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1002\/ejhf.592","article-title":"2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"18","author":"Ponikowski","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"2026080800515715200_ejhf1994-bib-0004","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/eurjhf\/hfp041","article-title":"Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology","volume":"11","author":"Jaarsma","year":"2009","journal-title":"Eur J Heart Fail"},{"key":"2026080800515715200_ejhf1994-bib-0005","first-page":"12","article-title":"Palliative care for people living with heart failure \u2013 European Association for Palliative Care Task Force expert position statement","volume":"16","author":"Sobanski","year":"2019","journal-title":"Cardiovasc Res"},{"key":"2026080800515715200_ejhf1994-bib-0006","author":"World Health Organisation","year":"2015"},{"key":"2026080800515715200_ejhf1994-bib-0007","doi-asserted-by":"crossref","first-page":"2340","DOI":"10.1002\/ejhf.1783","article-title":"The impact of palliative care on clinical and patient-centred outcomes in patients with advanced heart failure: a systematic review of randomized controlled trials","volume":"22","author":"Sahlollbey","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"2026080800515715200_ejhf1994-bib-0008","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1002\/ejhf.1768","article-title":"Task Force of the HFA Atlas, and the ESC Atlas of Cardiology leadership, developed in collaboration with the National Heart Failure Societies of the ESC member and ESC affiliated member countries. The Heart Failure Association Atlas: rationale, objectives, and methods","volume":"22","author":"Seferovi\u0107","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"2026080800515715200_ejhf1994-bib-0009","volume-title":"EAPC Atlas of Palliative Care in Europe 2019","author":"Arias-Casais","year":"2019"},{"key":"2026080800515715200_ejhf1994-bib-0010","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1177\/0269216314556565","article-title":"A survey of clinician attitude and self-reported practices regarding end-of-life care in heart failure","volume":"29","author":"Dunlay","year":"2015","journal-title":"Palliat Med"},{"key":"2026080800515715200_ejhf1994-bib-0011","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1089\/jpm.2016.0509","article-title":"The impact of communication skills training on cardiology fellows\u2019 and attending physicians\u2019 perceived comfort with difficult conversations","volume":"20","author":"Berlacher","year":"2017","journal-title":"J Palliat Med"},{"key":"2026080800515715200_ejhf1994-bib-0012","doi-asserted-by":"crossref","first-page":"2492","DOI":"10.1056\/NEJMp1900584","article-title":"Serious illness care 2.0 \u2013 meeting the needs of patients with heart failure","volume":"380","author":"Warraich","year":"2019","journal-title":"N Engl J Med"},{"key":"2026080800515715200_ejhf1994-bib-0013","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.113.000544","article-title":"Not the \u2018Grim Reaper Service\u201d: an assessment of provider knowledge, attitudes, and perceptions regarding palliative care referral barriers in heart failure","volume":"3","author":"Kavalieratos","year":"2014","journal-title":"J Am Heart Assoc"},{"key":"2026080800515715200_ejhf1994-bib-0014","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1093\/europace\/euq272","article-title":"Deactivation of implantable cardioverter-defibrillators at the end of life: results of the EHRA survey","volume":"12","author":"Marinski","year":"2010","journal-title":"Europace"},{"key":"2026080800515715200_ejhf1994-bib-0015","doi-asserted-by":"crossref","DOI":"10.1136\/bmjspcare-2015-000894","article-title":"Impacts of person-centred integrated chronic heart failure and palliative home care on pharmacological heart failure treatment: a substudy of a randomised trial","volume":"9","author":"Markgren","year":"2019","journal-title":"BMJ Support Palliat Care"},{"key":"2026080800515715200_ejhf1994-bib-0016","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijcard.2015.03.154","article-title":"Prognostic scores in heart failure \u2013 critical appraisal and practical use","volume":"188","author":"Ferrero","year":"2015","journal-title":"Int J Cardiol"},{"key":"2026080800515715200_ejhf1994-bib-0017","first-page":"444","article-title":"Symptom evaluation in palliative medicine: patient report vs systematic assessment","volume":"14","author":"Homsi","year":"2006","journal-title":"Support Care Cancer"},{"key":"2026080800515715200_ejhf1994-bib-0018","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s12955-018-0874-2","article-title":"CHF-PROM: validation of a patient-reported outcome measure for patients with chronic heart failure","volume":"16","author":"Tian","year":"2018","journal-title":"Health Qual Life Outcomes"},{"key":"2026080800515715200_ejhf1994-bib-0019","doi-asserted-by":"crossref","first-page":"e232","DOI":"10.1161\/CIR.0000000000000525","article-title":"Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association","volume":"136","author":"Van Diepen","year":"2017","journal-title":"Circulation"},{"key":"2026080800515715200_ejhf1994-bib-0020","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1111\/jan.12768","article-title":"A family-focused intervention for heart failure self-care: conceptual underpinnings of a culturally appropriate intervention","volume":"72","author":"Deek","year":"2015","journal-title":"J Adv Nurs"},{"key":"2026080800515715200_ejhf1994-bib-0021","first-page":"2993","article-title":"Negotiating cross-cultural issues at the end of life: \u201cYou got to go where he lives","volume":"286","author":"Kagawa-Singer","year":"2001","journal-title":"JAMA Intern Med"},{"key":"2026080800515715200_ejhf1994-bib-0022","doi-asserted-by":"crossref","first-page":"154","DOI":"10.4103\/2229-5151.84804","article-title":"Cultural and religious aspects of palliative care","volume":"1","author":"Steinberg","year":"2011","journal-title":"Int J Crit Illn Inj Sci"},{"key":"2026080800515715200_ejhf1994-bib-0023","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1002\/ejhf.151","article-title":"Effects of person-centred and integrated chronic heart failure and palliative home care. 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