Integrating Palliative Care into Cardiology: Lessons from Clinical Practice

Since the early 2000s, the role of palliative care for people living with heart failure has rapidly expanded. With the advent of new and evolving cardiovascular therapies, there is a growing need for comprehensive, holistic care that addresses not only medical complexity but also the emotional, social, spiritual, and practical challenges patients face. But how do palliative care and cardiology intersect? How can partnerships with cardiology teams develop over time to define palliative care’s role for patients with heart failure?

This blog explores these questions, sharing lessons from adult and pediatric palliative practice. Every program is different, but the fundamental challenge remains the same: building partnerships that enhance patient care while adapting to the changing landscape of cardiac treatment.

Traditionally, palliative care and cardiology have operated in silos, often connecting only when a patient is very advanced in their illness and does not have further treatment options. As treatment for heart failure and other cardiac conditions evolve, we have an opportunity to define palliative care’s role: What does palliative care look like in a cardiology program? When should we consult palliative care? How can this collaboration improve outcomes?

Cardiology has undergone transformative changes in the past two decades. New interventions—such as mechanical circulatory assist devices (MCSDs), transcatheter aortic valve replacements (TAVRs), and novel pharmacologic therapies—have extended the lives of patients with serious cardiac disease. These advances create new opportunities for palliative care to provide meaningful support for patients and families throughout the disease course.

However, misconceptions remain. Cardiovascular care is often symptom-centered, and hesitance to involve palliative care may stem from a perceived overlap in skill sets. Given this, some cardiology clinicians overlook the big picture of what palliative care can offer: a focus on symptom management, caregiver support, advance care planning, and navigating complex treatment options to ensure our care matches what matters most to patients, well before a crisis occurs. The earlier palliative care becomes involved, the more it can help optimize quality of life while cardiology teams focus on disease-directed treatment.

Growth in palliative cardiology has been driven by the introduction of professional organization-sponsored guidelines and accreditation requirements. Organizations such as The Joint Commission, the American Heart Association (AHA), and Medicare recommend or require the integration of palliative care into cardiovascular care, especially when considering advanced therapies like home inotropes or MCSDs.

However, these guidelines lack specificity about how palliative care should be delivered. This means that individual palliative care teams have flexibility to define their roles based on available resources and expertise—whether that means comprehensive inpatient consultation to outpatient visits. The AHA is currently performing an evaluation of the heart failure referral pathway to deliver specialty palliative care consultations to people who meet criteria based on disease burden and palliative care need. Future work should continue to focus on establishing a consensus of what constitutes high-quality palliative care in cardiology.

Despite progress, too often referral to palliative care happens late in the disease course. While this is not unique to cardiology, the evolving treatment landscape makes earlier integration increasingly important. While inpatient palliative care for patients in crisis is a necessity, the greatest opportunity for upstream intervention lies in ambulatory care, where we can support patients before the need for hospitalization.

Two decades ago, options for end-stage heart failure were limited. Today, with home inotropes and MCSDs, individuals are living longer despite significant disease burden. This shift has made decision-making more complex, requiring ongoing conversations about risks, benefits, and long-term quality of life. Palliative care is uniquely equipped to facilitate these conversations, ensuring that patients and families understand their options and make value-aligned choices.

How and when palliative care is integrated into cardiovascular care widely varies across health systems. Some programs—most often in academic medical centers—have dedicated adult and pediatric palliative care cardiology programs, while others integrate palliative care into the cardiology service.

Successful integration of palliative care into cardiology requires a thoughtful, gradual approach, which is supported by guideline recommendations and payer requirements.

In many cases, a single palliative care clinician, such as a nurse, embeds themselves into a cardiology team, attending rounds, observing workflows, and identifying areas where palliative care can contribute. Over time, as cardiology colleagues see tangible benefits, including better symptom management, improved communication, and enhanced patient and family support, referrals tend to grow. The key is to demonstrate value through action: showing up, listening, and providing meaningful support that builds credibility and trust. Net/net, palliative care leaders must continue to educate cardiology colleagues on our value, from helping patients navigate treatment decisions, managing symptoms, or supporting families, long before a crisis occurs.

At our organization, the University of Alabama at Birmingham, palliative care’s initial involvement was minimal; two cardiology clinicians recognized its value while others remained uncertain. That Medicare requires palliative consultation for Left Ventricular Assist Device (LVAD) evaluation certainly helped drive the initial push, and our entry point was simple: being present, listening, and identifying small ways to contribute.

Embedding a palliative care nurse within the inpatient team was the key to our success. This clinician started joining rounds, learned the team’s workflow, understood challenges, and carefully identified gaps where palliative care could add value. Over time, as we demonstrated our contributions—whether through symptom management, facilitating difficult conversations, or supporting family decision-making—consults naturally increased. As our ambulatory practice grew, cardiology was able to see the value of longitudinal collaboration with the palliative care team, because we could offer ongoing support for patients and families living with advanced heart disease in the community.

Given high consult volume and limited resources, our team developed a structured, tiered consultation model for cardiology patients, especially those undergoing LVAD evaluation (a Joint Commission requirement). This framework can be adapted by other teams seeking to integrate palliative care within cardiology.

• Introduces palliative care and assesses needs, screening for uncontrolled symptoms, psychosocial concerns, and decision-making needs
• Determines whether further palliative team involvement is necessary

• Patients with high distress may be referred to counseling, social work, or spiritual care
• Patients with poorly controlled symptoms or complex decision-making needs are escalated to a palliative care provider
• Either pathway may lead to ongoing support through our ambulatory clinic

• Patients who do not initially require intensive palliative care involvement can re-engage with a consult as their clinical trajectory and needs change
• Common reassessment triggers include refractory symptoms or complications such as LVAD infections, strokes, or bleeding events that prompt new goals-of-care discussions

This model allows us to optimize our limited resources, while ensuring patients receive the appropriate level of support.

As the field continues to grow it’s likely that palliative care in cardiology will become more standardized, much like it has in oncology. Ongoing research, such as the AHA’s evaluation of the heart failure referral pathway, and collaboration will refine best practices and ensure that people receive the right level of support at the right time.

For now, the focus remains on building relationships, demonstrating the value of palliative care, and adapting services to meet the needs of both patients and cardiology teams. By effectively partnering with cardiology, palliative care clinicians can help shape the future of care for cardiovascular patients—offering support throughout the entire course of their illness.