• palliative care
• heart failure management

Patients with heart failure and those with advanced malignant disease, who are the main focus of palliative care specialists, share many physical, psychological, and social problems. However, it might be inferred from the respective standard textbooks that cardiology and palliative care are mutually exclusive disciplines; neither refers to the other, the former failing to mention palliative care even when detailing the management of end stage cardiac failure,¹ while the Oxford textbook of palliative care² does not envisage the extension of palliative care programmes beyond their present scope. There have, however, been a few articles from palliative care teams and cardiologists,³ epidemiologists,⁴ and psychiatrists⁵ which have begun to redress this situation by highlighting the problems faced by heart failure patients during the final months and days of life. The identified deficiencies in their care are compelling and need to be addressed. Conventional cardiological treatments are demonstrably inadequate or inappropriate for solving these problems, but some of the skills and experience acquired in palliative care could be adopted, or adapted to do so.

A common misconception is that palliative care is specifically for the management of patients in the terminal stages of malignant disease. This is, in effect, a paraphrase of the Oxford textbook of palliative care definition² and reflects the origins of palliative care in the hospice movement for the care of cancer patients. The World Health Organization, while also focusing exclusively on cancer patients, elaborates on the scope of the care which should be provided: “the active total care of patients . . .control of pain, of other symptoms and of psychological, social and spiritual problems is paramount”.⁶ It notes that “Many aspects of palliative care are also applicable earlier in the course of the illness” and that it “offers a support system …