{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T19:16:07Z","timestamp":1790363767398,"version":"4.1.0"},"reference-count":41,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geriatrics"],"abstract":"<jats:p>Background: Advanced heart failure (HF) in very old patients follows an unpredictable trajectory marked by recurrent decompensations, progressive functional decline, and high mortality. In this population, decision-making regarding goals of care and treatment proportionality is particularly complex due to multimorbidity, frailty, cognitive vulnerability, and prognostic uncertainty, and remains insufficiently addressed by conventional disease-centred heart failure pathways. Methods: This narrative review synthesizes current evidence from heart-failure guidelines, geriatric medicine, and palliative care literature to propose a cardiogeriatric framework for end-of-life decision-making in advanced HF. Results: In older adults, functional decline and geriatric vulnerability often progress independently of cardiac parameters, limiting the relevance of prognosis-based thresholds. The palliative turning point should be understood as a multidimensional process resulting from converging cardiological, geriatric, organizational, and patient-reported signals. Therapeutic decisions should be guided by proportionality between expected benefit, treatment burden, and patient priorities. Longitudinal, iterative communication is essential to align care with evolving goals. Conclusions: A cardiogeriatric approach integrating cardiology, geriatrics, and palliative principles supports timely palliative integration, shared decision-making, and coordinated care in very old patients with advanced HF.<\/jats:p>","DOI":"10.3390\/geriatrics11020034","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T10:07:13Z","timestamp":1774433233000},"page":"34","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Integrating a Palliative Approach into Cardiogeriatric Decision-Making for Frail Older Adults with Heart Failure"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8002-4845","authenticated-orcid":false,"given":"R\u00e9mi","family":"Esser","sequence":"first","affiliation":[{"name":"Cardiogeriatrics Department, H\u00f4pital La Porte Verte, 78000 Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8000-8962","authenticated-orcid":false,"given":"Marine","family":"Larbaneix","sequence":"additional","affiliation":[{"name":"Cardiogeriatrics Department, H\u00f4pital La Porte Verte, 78000 Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Mondragon","sequence":"additional","affiliation":[{"name":"Cardiogeriatrics Department, H\u00f4pital La Porte Verte, 78000 Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marl\u00e8ne","family":"Esteban","sequence":"additional","affiliation":[{"name":"Cardiogeriatrics Department, H\u00f4pital La Porte Verte, 78000 Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Farges","sequence":"additional","affiliation":[{"name":"Cardiogeriatrics Department, H\u00f4pital La Porte Verte, 78000 Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0383-6765","authenticated-orcid":false,"given":"Sophie","family":"Nisse Durgeat","sequence":"additional","affiliation":[{"name":"Medical Affairs, NP Medical, 33000 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Harboun","sequence":"additional","affiliation":[{"name":"Cardiogeriatrics Department, H\u00f4pital La Porte Verte, 78000 Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Maurou","sequence":"additional","affiliation":[{"name":"Cardiogeriatrics Department, H\u00f4pital La Porte Verte, 78000 Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1016\/S0140-6736(17)31071-1","article-title":"Heart failure","volume":"390","author":"Metra","year":"2017","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1002\/ejhf.1236","article-title":"Advanced heart failure: A position statement of the Heart Failure Association of the European Society of Cardiology","volume":"20","author":"Metra","year":"2018","journal-title":"Eur. J. Heart Fail."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.healun.2009.02.015","article-title":"INTERMACS profiles of advanced heart failure: The current picture","volume":"28","author":"Stevenson","year":"2009","journal-title":"J. Heart Lung Transplant."},{"key":"ref_5","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":"ref_6","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1177\/0269216314531999","article-title":"The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: A systematic review of views from patients, carers and health-care professionals","volume":"28","author":"Oishi","year":"2014","journal-title":"Palliat. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.jacc.2017.05.030","article-title":"Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial","volume":"70","author":"Rogers","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2104","DOI":"10.1001\/jama.2016.16840","article-title":"Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis","volume":"316","author":"Kavalieratos","year":"2016","journal-title":"JAMA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1002\/ejhf.1611","article-title":"Heart Failure Association\/European Society of Cardiology position paper on frailty in patients with heart failure","volume":"21","author":"Vitale","year":"2019","journal-title":"Eur. J. Heart Fail."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.jacc.2013.09.070","article-title":"Frailty assessment in the cardiovascular care of older adults","volume":"63","author":"Afilalo","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1016\/j.jacc.2018.02.059","article-title":"Domain Management Approach to Heart Failure in the Geriatric Patient: Present and Future","volume":"71","author":"Gorodeski","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"m2257","DOI":"10.1136\/bmj.m2257","article-title":"Association between palliative care and healthcare outcomes among adults with terminal non-cancer illness: Population based matched cohort study","volume":"370","author":"Quinn","year":"2020","journal-title":"BMJ"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.jacc.2009.02.078","article-title":"Palliative care in congestive heart failure","volume":"54","author":"Goodlin","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2492","DOI":"10.1056\/NEJMp1900584","article-title":"Serious-Illness Care 2.0\u2014Meeting the Needs of Patients with Heart Failure","volume":"380","author":"Warraich","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: Evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1007\/s10741-015-9493-8","article-title":"Frailty in advanced heart failure: A systematic review","volume":"20","author":"Jha","year":"2015","journal-title":"Heart Fail. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.jamda.2013.03.022","article-title":"Frailty consensus: A call to action","volume":"14","author":"Morley","year":"2013","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1001\/jamainternmed.2017.8667","article-title":"Effect of a Collaborative Care Intervention vs Usual Care on Health Status of Patients with Chronic Heart Failure: The CASA Randomized Clinical Trial","volume":"178","author":"Bekelman","year":"2018","journal-title":"JAMA Intern. Med."},{"key":"ref_19","unstructured":"World Health Organization (2026, March 04). Palliative Care, Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/palliative-care."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.2215\/CJN.04840516","article-title":"Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease","volume":"11","author":"Murtagh","year":"2016","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Etkind, S.N., Bone, A.E., Gomes, B., Lovell, N., Evans, C.J., Higginson, I.J., and Murtagh, F.E.M. (2017). How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Med., 15.","DOI":"10.1186\/s12916-017-0860-2"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1161\/CIRCULATIONAHA.105.584102","article-title":"The Seattle Heart Failure Model: Prediction of survival in heart failure","volume":"113","author":"Levy","year":"2006","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1093\/eurheartj\/ehs337","article-title":"Predicting survival in heart failure: A risk score based on 39 372 patients from 30 studies","volume":"34","author":"Pocock","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.amjmed.2007.08.035","article-title":"Physician attitudes toward end-stage heart failure: A national survey","volume":"121","author":"Hauptman","year":"2008","journal-title":"Am. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.jacc.2025.09.1590","article-title":"Frailty Scale Captures Multidimensional Vulnerability and Predicts Mortality in Heart Failure","volume":"87","author":"Nakade","year":"2026","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1001\/archinte.166.6.605","article-title":"Reconsidering medication appropriateness for patients late in life","volume":"166","author":"Holmes","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1001\/jamainternmed.2015.0289","article-title":"Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: A randomized clinical trial","volume":"175","author":"Kutner","year":"2015","journal-title":"JAMA Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.1016\/j.jacc.2008.08.028","article-title":"Changing preferences for survival after hospitalization with advanced heart failure","volume":"52","author":"Stevenson","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1016\/j.hrthm.2010.04.033","article-title":"HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy","volume":"7","author":"Lampert","year":"2010","journal-title":"Heart Rhythm."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"101933","DOI":"10.1016\/j.ancard.2025.101933","article-title":"DOME-HF: \u00e9valuation r\u00e9trospective sur six mois de la prise en charge diur\u00e9tique ambulatoire chez des patients \u00e2g\u00e9s atteints d\u2019insuffisance cardiaque [DOME-HF\u2014A retrospective six-month evaluation of Diuretic Outpatient Management in Elderly Heart Failure patients]","volume":"74","author":"Esteban","year":"2025","journal-title":"Ann. Cardiol. Angeiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"c1345","DOI":"10.1136\/bmj.c1345","article-title":"The impact of advance care planning on end of life care in elderly patients: Randomised controlled trial","volume":"340","author":"Detering","year":"2010","journal-title":"BMJ"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1994","DOI":"10.1001\/jamainternmed.2014.5271","article-title":"American College of Physicians High Value Care Task Force. Communication about serious illness care goals: A review and synthesis of best practices","volume":"174","author":"Bernacki","year":"2014","journal-title":"JAMA Intern. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.cger.2017.01.004","article-title":"The Role of Patient Preferences in Deprescribing","volume":"33","author":"Holmes","year":"2017","journal-title":"Clin. Geriatr. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"835","DOI":"10.7326\/0003-4819-141-11-200412070-00006","article-title":"Management of implantable cardioverter defibrillators in end-of-life care","volume":"141","author":"Goldstein","year":"2004","journal-title":"Ann. Intern. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1002\/ehf2.12677","article-title":"Outpatient treatment of worsening heart failure with intravenous and subcutaneous diuretics: A systematic review of the literature","volume":"7","author":"Wierda","year":"2020","journal-title":"ESC Heart Fail."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.jpainsymman.2016.12.331","article-title":"Defining Advance Care Planning for Adults: A Consensus Definition from a Multidisciplinary Delphi Panel","volume":"53","author":"Sudore","year":"2017","journal-title":"J. Pain Symptom Manag."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.3399\/bjgp11X549018","article-title":"End-of-life care conversations with heart failure patients: A systematic literature review and narrative synthesis","volume":"61","author":"Barclay","year":"2011","journal-title":"Br. J. Gen. Pract."},{"key":"ref_38","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. PREFER: A randomized controlled study","volume":"16","author":"Boman","year":"2014","journal-title":"Eur. J. Heart Fail."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1089\/jpm.2014.0192","article-title":"Inpatient palliative care for patients with acute heart failure: Outcomes from a randomized trial","volume":"18","author":"Sidebottom","year":"2015","journal-title":"J. Palliat. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1016\/j.jacc.2017.07.735","article-title":"How Medicine Has Changed the End of Life for Patients with Cardiovascular Disease","volume":"70","author":"Warraich","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1056\/NEJMoa1000678","article-title":"Early palliative care for patients with metastatic non-small-cell lung cancer","volume":"363","author":"Temel","year":"2010","journal-title":"N. Engl. J. Med."}],"container-title":["Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3417\/11\/2\/34\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T10:59:01Z","timestamp":1774436341000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3417\/11\/2\/34"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,25]]},"references-count":41,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["geriatrics11020034"],"URL":"https:\/\/doi.org\/10.3390\/geriatrics11020034","relation":{},"ISSN":["2308-3417"],"issn-type":[{"value":"2308-3417","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,25]]}}}