Palliative care and decision making in advanced heart failure.

OPINION STATEMENT: The diagnosis of advanced heart failure (HF) is established in patients for whom symptoms are refractory to guideline-directed therapies. Palliative care (PC) is based on symptom management and support of the patient and family, making its integration into the care of those with advanced HF essential. Comorbidities including frailty, cognitive dysfunction, and depression are often under-recognized in patients with advanced HF and may correlate with outcomes. Decisions should be based on the patient's values, goals agreed upon by the clinician with the patient, and what is medically reasonable. Palliative Care should be integrated to help with both palliation of symptoms and support for families and patients.