Integration of palliative care and heart failure services: Mapping National Data to Inform Service Provision

Background: Palliative care is recommended for people with heart failure in national and international guidelines. However, palliative care provision is often implemented late in the disease trajectory, if at all. Understanding current practices is necessary to address service gaps and inform development of heart failure services.
Aim/Research question or hypothesis: To map palliative care services available for people with heart failure in Northern Ireland (NI). To use this knowledge to develop recommendations that will improve healthcare delivery for people with heart failure who have palliative care needs.
Methods: A regional mapping exercise was conducted using a validated, online Pavlovia survey with multiprofessional health service experts (nursing and medical) who have a responsibility for the care of patients with heart failure across all five health and social care trusts in NI. The resulting anonymised quantitative data underwent descriptive statistical analysis, and free-text qualitative responses were subjected to codebook thematic analysis and mapped to quantitative findings.
Results: Lead heart failure clinicians across the region participated (n=10). A number of gaps in palliative care provision for people with heart failure were identified, including: inconsistent completion of advance care plans; limited use of systematic templates/tools to guide holistic palliative care needs assessment; varying awareness of locally agreed eligibility criteria for specialist palliative care; and inequity of palliative care provision for people who have heart failure with preserved ejection fraction. Palliative care provision also varied depending on location, with some trust areas having more access to specialist palliative care than others,
Discussion: Although the study identified gaps in palliative care provision, many participating heart failure clinicians recognised the value in palliative care services. Recommendations for service improvement should include adequate resources to meet escalating needs, systematic tools for holistic assessment, accessible advance care plans, and regionally standardised and agreed criteria for referrals to specialist palliative care services.