Improving end-of-life care in advanced heart failure: the role of a multidisciplinary committee
T Roig, E Santiago-Vacas, E Zamora, M Domingo, T Jimenez, M Troya, G Guix, A Arjol, E Hoyos, M Bonet, A Borrellas, P Codina, B Gonzalez, M A Mas, A Bayes-GenisAbstract
Background/Introduction
Advanced chronic heart failure (HF) is associated with a high symptom burden, frequent hospitalizations, and complex decision-making regarding therapeutic limits and end-of-life care. Fragmented care and poor coordination between hospital and community settings often hinder shared decision-making and the implementation of patient preferences.
Purpose
To describe the initial experience of a multidisciplinary clinical committee for patients with advanced HF treated in a specialized HF Unit, aimed at improving clinical decision-making, advance care planning, and continuity of care between hospital and community settings.
Methods
Observational study including 32 consecutively discussed patients in a multidisciplinary HF committee at a HF Unit in a tertiary hospital between April 2024 and December 2025. The committee included cardiologists, geriatricians, nephrologists, internists, general practitioners and nurses and met monthly with hospital and community teams to ensure shared decision-making and care continuity. Variables collected included age, HF phenotype, functional and frailty indexes, cognitive impairment, agreed therapeutic ceiling, place of death, and concordance between committee decisions and end-of-life care.
Results
Thirty-two patients with advanced HF were discussed (mean age 80.7±7.1 years; 56.3% male). Preserved ejection fraction was the most frequent HF phenotype (46.9%). Cognitive impairment was present in 25% of patients. A therapeutic ceiling was agreed upon in all cases. During follow-up, 53.1% of patients died, with a median time to death of 67.1±87.3 days (between comittee’s day and the death). Death occurred at home in 35.3% and in intermediate care centers in 41.2%. Patient preferences and committee decisions were respected in 73.1% of cases.
Conclusion(s)
A structured multidisciplinary committee for patients with advanced HF is feasible and may improve shared decision-making, advance care planning, and continuity of care across settings, helping to align end-of-life care with patient and family preferences. Further studies are needed to assess its impact on clinical outcomes.