Criteria for Referral of Patients With Advanced Heart Failure for Specialized Palliative Care

Yuchieh Kathryn Chang, Larry A Allen, John A McClung, Martin A Denvir, Jennifer Philip, Masanori Mori, Pedro Perez-Cruz, Shao-Yi Cheng, Anna Collins, David Hui*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: Patients with advanced heart failure have substantial supportive care needs. Specialist palliative care can be beneficial, but it is unclear who is most appropriate for referral and when patients should be referred. Objectives: We conducted a Delphi study of international experts to identify consensus referral criteria for specialist palliative care for patients with advanced heart failure. Methods: Clinicians from 5 continents with expertise in the integration of cardiology and palliative care were asked to rate 34 disease-based, 24 needs-based, and 9 time-based criteria over 3 rounds. Consensus was defined a priori as ≥70% agreement. A criterion was coded as major if the experts endorsed that meeting that criterion alone was adequate to justify a referral. Results: The response rate was 44 of 46 (96%), 41 of 46 (89%), and 43 of 46 (93%) in the first, second, and third rounds, respectively. Panelists reached consensus on 25 major criteria for specialist palliative care referral. The 25 major criteria were categorized under 6 topics, including “advanced/refractory heart failure, comorbidities, and complications” (eg, cardiac cachexia, cardiorenal syndrome) (n = 8), “advanced heart failure therapies” (eg, chronic inotropes, precardiac transplant) (n = 4), “hospital utilization” (eg, emergency room visits, hospitalization) (n = 2), “prognostic estimate” (n = 1), “symptom burden/distress” (eg, severe physical/emotional/spiritual distress) (n = 6), and “decision making/social support” (eg, goals-of-care discussions) (n = 4). The majority (68%) of major criteria had ≥90% agreement. Conclusions: International experts reached consensus on a large number of criteria for referral to specialist palliative care. With further validation, these criteria may be useful for standardizing palliative care access in the inpatient and/or outpatient settings.

Original languageEnglish
Pages (from-to)332-344
JournalJournal of the American College of Cardiology
Issue number4
Publication statusPublished - 18 Jul 2022

Keywords / Materials (for Non-textual outputs)

  • Delphi Technique
  • Heart Failure
  • Palliative Care
  • Patient Selection
  • Referral and Consultation
  • Supportive care


Dive into the research topics of 'Criteria for Referral of Patients With Advanced Heart Failure for Specialized Palliative Care'. Together they form a unique fingerprint.

Cite this