Integration of palliative care and heart failure services: Mapping national data to inform policy and service provision

Introduction
Although palliative care is recommended for people with heart failure in national and international guidelines, it is still not part of routine heart failure management. There is thus a need to understand current practices to address service gaps through informing future policy.

Aims
Aim: To map the palliative care services available for people with heart failure in Northern Ireland and determine how palliative care access is facilitated. Using this knowledge, we will make recommendations for policy change to impact healthcare for people with heart failure who have palliative care needs.

Design/methods
A national mapping exercise was conducted via an online survey with health service experts, who have a responsibility for the care of patients with heart failure in Northern Ireland. Expert clinicians in all five Trusts were approached as their specific knowledge and expertise was deemed highly relevant to the study. The resulting quantitative anonymised data underwent descriptive statistical analysis, and free-text qualitative responses were subjected to codebook thematic analysis and mapped to quantitative findings.

Results
Key findings included opportunities to enhance integration of palliative care into heart failure services, particularly with respect to geographical variation. Areas for improvement include: inconsistent completion of advance care plans; limited use of systematic templates/tools to guide holistic assessment; varying awareness of locally agreed eligibility criteria for specialist palliative care; and inequity of care for people who have heart failure with preserved ejection fraction.

Conclusions/Implications
The gaps in integration of palliative care are significant, however the majority of clinicians who took part in this study saw value in palliative care services. Policy recommendations should include adequate resources to meet escalating needs, systematic tools for holistic assessment, accessible advance care plans, and universally known eligibility criteria for referrals to specialist palliative care when needed.