Integration of palliative care in management of advanced heart failure in older people: a case-based educational review

Heart failure (HF)—a highly prevalent condition among older adults—is characterized by recurrent exacerbations and progressive symptom burden, significantly affecting functional autonomy and quality of life. Palliative care may alleviate symptoms and improve quality of life for patients and their families, promoting personalized care aligned with individual preferences. Although international guidelines recommend the early integration of palliative care into standard HF management, its implementation in real-world practice remains limited. Improving awareness and competencies in identifying end-of-life needs and in advance care planning may facilitate earlier integration of palliative care into HF clinical pathways. This paper presents a case of advanced HF in which palliative care was introduced only during the final hospitalization, highlighting the importance of the earlier integration of palliative care throughout the disease trajectory. This paper results from a collaboration between young members of the Italian Society of Palliative Care and the Italian Society of Gerontology and Geriatrics. The case serves as a practical training model for healthcare professionals in applying a palliative care approach to advanced HF. It illustrates key strategies and tools employed across different stages of care, including patient identification, multidimensional assessment, shared decision-making, advance care planning, symptom management, medication review, and palliative sedation.