Palliative care for heart failure in Northern Ireland shows major gaps: limited need assessment scope, no systematic tools, uneven referral criteria knowledge, and inequity by heart failure type.
A national survey in Northern Ireland reveals significant gaps and inequities in the integration of palliative care into heart failure services, particularly for patients with HFpEF.
Background: Although palliative care is recommended for people with heart failure in various national and international guidelines, there remains no universally adopted standard on how and when to integrate it into heart failure care. Objective: To map the palliative care services available for people with heart failure in 1 country within the United Kingdom and to determine how palliative care access for people with heart failure is implemented across the country. Methods: An online survey was used to map palliative care services available for people with heart failure. Both quantitative and qualitative responses were gathered. Responses were gathered from heart failure experts, who represented heart failure service provision across the healthcare system within Northern Ireland. Results: It was found that there are gaps in integration of palliative care services into heart failure services, evidenced by 5 key findings: assessment for palliative care needs was restricted to end-of-life; no agreed systematic tool/template implemented to guide holistic assessment of unmet supportive and palliative care needs; locally agreed eligibility criteria for specialist palliative care referral not universally known; advance care plans not completed routinely, and mainly by palliative care physicians; and inequity of palliative care provision for those with heart failure with preserved ejection fraction compared with those with heart failure with reduced ejection fraction. It was also evident that the integration of palliative care into heart failure services was determined by locality. Conclusions: We identified gaps in palliative care provision for people impacted by heart failure. This enables recognition and response to these gaps to ensure delivery meets the needs of those individuals within our communities who have heart failure and palliative care needs.
Miller et al. (2026) studied this question. Palliative care for heart failure in Northern Ireland shows major gaps: limited need assessment scope, no systematic tools, uneven referral criteria knowledge, and inequity by heart failure type.