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Background: People with advanced heart failure have repeated hospital admissions. Advance care planning can support patient preferences, but studies in people with heart failure have not been assessed. Aim: To evaluate the literature regarding advance care planning in heart failure. Design: Systematic review and narrative analysis (PROSPERO CRD42017059190). Data sources: Electronic databases were searched (1990 to 23 March 2017): MEDLINE(R), Cochrane Library, CINAHL and Scopus. Four journals were hand searched. Two independent researchers screened against eligibility criteria. One reviewer extracted all data and a sample by a second. Quality was assessed by Cochrane Risk of Bias or the Critical Appraisal Skills Programme Tool for Cohort Studies. Results: Out of the 1713 articles, 8 were included representing 14,357 participants from in/outpatient settings from five countries. Two randomised controlled trials and one observational study assessed planning as part of a specialist palliative care intervention; one randomised controlled trial assessed planning in addition to usual cardiology care; one randomised controlled trial and one observational study assessed planning in an integrated cardiology–palliative care model; one observational study assessed evidence of planning (advance directive) as part of usual care and one observational study was a secondary analysis of trial participants coded Do Not Attempt Cardiopulmonary Resuscitation. Advance care planning: (1) reduced hospitalisation (5/7 studies); (2) increased referral/use of palliative services (4/4 studies); and (3) supported deaths in the patient-preferred place (2/2 studies). Conclusion: Advance care planning as part of specialist palliative care reduces hospitalisation. Preliminary studies of planning integrated into generic care, accessing specialist palliative care support if needed, are promising. [ABSTRACT FROM AUTHOR]

The article discusses the summary of the evidence and future direction of palliative care for patients with heart failure in Great Britain. It outlines the barriers in accessing palliative care services including the difficulty of prognostication and inadequacy of discussions about end-of-life care. It mentions the gap in the symptom control evidence other than pain and dyspnoea. It also defines heart failure as a disease with psychological and physical burdens for patients and their families.