{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:12:09Z","timestamp":1791472329280,"version":"4.3.4"},"reference-count":121,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T00:00:00Z","timestamp":1770422400000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Integrating end\u2010of\u2010life (EoL) care in cardiac intensive care units (CICUs) is particularly complex because it requires a shift from a purely curative approach to one that emphasizes symptom management, emotional and spiritual support and patient\u2010centered care. Moreover, this transition is challenging due to the need to balance life\u2010sustaining treatments with the goals of comfort and dignity. The concept of EoL care varies across countries and is influenced by cultural, ethical and legal factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This narrative review examines palliative and EoL care in critically ill cardiac patients, including those with advanced heart failure, cardiogenic shock and other acute or chronic cardiac conditions, with a focus on models of care, multidisciplinary team involvement, ethical challenges and barriers to implementation in the CICU setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Key candidates for palliative care (PC) in heart disease include patients with advanced heart failure, cardiogenic shock and other acute or chronic cardiac conditions; however, its implementation remains limited compared to other disciplines, such as oncology. In EoL care, multidisciplinary teams, including cardiologists, nurses, PC specialists and social workers, play a crucial role in providing holistic care. Effective communication with patients and their families is essential for aligning treatment with individual values and goals. Ethical dilemmas, such as the withdrawal of life\u2010sustaining treatments and the deactivation of implanted cardiac devices, require compassionate and transparent decision\u2010making. Unlike previous reviews, this work specifically highlights the timing of palliative care integration as the main factor influencing patient outcomes and family experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Timely integration of palliative care in the CICU remains a major challenge. Significant gaps persist in training, resource allocation and quality indicators for palliative and EoL care. Addressing these shortcomings through enhanced education, standardized protocols and rigorous research is essential to ensure the effective delivery of PC in the CICU setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/eci.70174","type":"journal-article","created":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T10:57:01Z","timestamp":1770461821000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Improving end\u2010of\u2010life care in the cardiac intensive care unit: Navigating the challenge of timing palliative care intervention"],"prefix":"10.1111","volume":"56","author":[{"given":"Simona","family":"Giubilato","sequence":"first","affiliation":[{"name":"Cardiology Department Cannizzaro Hospital  Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4146-7099","authenticated-orcid":false,"given":"Roberta","family":"Della Bona","sequence":"additional","affiliation":[{"name":"Cardiovascular Disease Unit IRCCS Ospedale Policlinico San Martino  Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8341-1427","authenticated-orcid":false,"given":"Alessia","family":"Gambaro","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta","family":"Sorini\u2010Dini","sequence":"additional","affiliation":[{"name":"U.O.C. 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Antonio Abate Hospital, ASP  Trapani, Erice Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmine","family":"Riccio","sequence":"additional","affiliation":[{"name":"Cardiovascular Department Sant'anna e San Sebastiano Hospital  Caserta Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Di Lenarda","sequence":"additional","affiliation":[{"name":"Cardiovascular Center University Hospital and Health Services of Trieste  Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele Massimo","family":"Gulizia","sequence":"additional","affiliation":[{"name":"U.O.C. Cardiologia, Ospedale Garibaldi\u2010Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione \u2018Garibaldi\u2019  Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Grimaldi","sequence":"additional","affiliation":[{"name":"Department of Cardiology General Regional Hospital \u2018F. 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