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Palliative care in cardiovascular medicine.

European heart journal

Authors: Endrit Cekaj, Frederik Sand, David H V Vogel, Peter M Spieth, Benedikt Schrage, Aitor Uribarri, Frederic De Roeck, Jordi Riera, Federico Pappalardo, Norman Mangner, Guido Tavazzi, Tom Verbelen, Christian Jung, Andreas Schäfer, Dirk Westermann, Sebastian Zimmer, Malte Kelm, Stephan Baldus, Christian Hagl, Martin Neukirchen, Farhad Bakhtiary, Georg Nickenig, Steffen T Simon, Holger Thiele, Claudia Bausewein, Lukas Radbruch, Alexandra Philipsen, Enzo Lüsebrink

Cardiovascular disease remains the leading global cause of morbidity and mortality. Although advances in prevention, diagnostics, and disease-modifying therapies have prolonged survival, many individuals now live longer with high symptom burden, functional decline, and complex decisional needs. Palliative care (PC) for adults with advanced cardiovascular disease can improve quality of life, support caregivers, and align treatments with patient values and goals. Core elements include symptom management, effective communication, shared decision-making, advance care planning, and integration of psychosocial and spiritual support across the disease trajectory and different care settings. Current evidence demonstrates that early PC intervention can improve symptom control, enhance quality of life, reduce psychological distress, and decrease high-intensity yet low-value care near the end of life. Nevertheless, outside of heart failure populations, gaps in widespread PC implementation across populations supported with cardiac devices as well as across diverse cultural and health systems remain. This state-of-the-art review (i) synthesizes conceptual foundations, referral triggers, and delivery models for PC in cardiovascular medicine; (ii) reviews disease-specific considerations across heart failure, valvular disease, pulmonary hypertension, arrhythmias, and congenital heart disease; (iii) outlines ethical and legal issues including advance directives and device deactivation; (iv) provides practical guidance for symptom management and communication frameworks; and (v) proposes a pragmatic algorithm to support clinical integration of PC into cardiovascular medicine.

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PMID: 41879158

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