Addressing heart failure in palliative care:
an important message for the unique contribution of nursing to interprofessional collaboration

PHILIP J LARKIN

Full Professor of Palliative Care Nursing (retired), Palliative and Supportive Care Service, University Hospital of Lausanne, University of Lausanne, Switzerland.

Received on May 3, 2026




Heart failure remains one of the leading causes of hospitalization worldwide, placing a significant burden on healthcare systems and affecting patients’ quality of life. The early management of hospitalized patients with heart failure is a critical period that often determines clinical outcomes, including symptom stabilization, length of stay, and risk of readmission. Within this context, nurses play a pivotal role as frontline healthcare professionals who are continuously involved in patient monitoring, assessment, and intervention.

The findings of the scoping review presented in this edition of Rivista italiana di cure palliative, on the role of nursing in the early management of hospitalized heart failure patients raises important messages, not only for the evolving discipline of palliative care but for the significant role that nurses play in negotiating the clinical care pathways for patients and families (1).

Contemporary international thinking around palliative care has experienced a strategic shift, towards a focus on the early integration of palliative care across chronic life-limiting disease. The care of patients and families living with heart failure is one example of this and, as clearly expressed in this review, needs are multidimensional and complex. This has been supported in another recent publication by Chelazzi et al.2 Palliative care clearly has a potential role in collaborative cross-disciplinary care and management in this debilitating illness.

So what is the unique contribution of nursing in heart failure palliative care?

The potential role and expertise of nurses in palliative care is acknowledged at an international level. Key international reports and publications3-5 clearly indicate the need for nurses to be supported to take leadership roles in the delivery of palliative care to meet optimal outcomes for patients and caregivers. They argue that:

■ Nurses account for almost 60% of the healthcare workforce and for 90% of all patient healthcare contacts across the 24 hour trajectory of care.

■ There is a critical need to develop the workforce in terms of a strengthened agenda for nursing evidence to support the roles, functions and values of nursing practice and building institutional and leadership capacity in nurses.

■ There is also a need to focus on education which prepares nurses to be strategically placed within the sector to lead and address change.

■ Nurses can foster high quality patient and family care, with timely access and in their place of choice. Their potential is often unrecognized.

Considering these critical messages for the nursing profession, the findings of the scoping review add new evidence to support the role of the nurse as partner in care provision, advocate, decision-maker and manager.

Across the trajectory of hospitalization, nurses are responsible for recognizing early signs of deterioration, implementing evidence-based care, and ensuring timely communication within the multidisciplinary team. Their responsibilities extend beyond clinical tasks to include patient education, emotional support, and coordination of care, all of which are essential for effective disease management. By combining clinical expertise with patient-centered care, nurses significantly contribute to improving outcomes. They are often the first to detect subtle changes in a patient’s condition—such as worsening breathlessness, fluid overload, or vital sign instability, enabling prompt interventions and preventing clinical deterioration. Their actions directly influence symptom management and stabilization. Moreover, they act as a bridge between healthcare professionals, ensuring continuity and coherence in the treatment plan, improving self-care and life quality through helping patients understand their condition (a critical element in heart failure management). Beyond the immediate care, nurses also prepare for discharge and transitional care, working across sectors to maintain community resources and preventing re-hospitalization where possible. Palliative care nursing can support clinical expertise through having their visiblity strengthened within the multiprofessional team.

The data presented by Tombolini et al., supports many of these assertions, particulary the need for targeted education on palliative care across undergraduate and postgraduate programmes1. Palliative nursing education is topical and recent publications by nurse leaders on behalf of the European Association for Palliative Care attest to the range of competences needed by nurses to be effective practitioners, across physical, psychological, social and spiritual dimensions of care6,7. The question remains what do we need to do to meet the outcomes proposed by the reviews authors ?

First, palliative care is in transition and future services need to embrace the breadth of potential in what inclusive needs-focused, multiprofessional palliative care can be. It has been argued that palliative care is ‘everyone’s responsiblity’8. For hospitals, it is certainly an organizational responsiblity. There is an onus on hospitals to create the space which enables palliative care to be seen as a integral part of their statutory service delivery, given to all patients and families, determined by need and not disease.

Second, this re-framing of care also applies to how we can support the nursing profession in its development. Nurses also need space to grow in their professional practice and to be given opportunities to lead and shape care. With appropriate education, mentorship and guidance, nursing can contribute fully to the early detection, intervention, education, and continuity of care in heart failure management. We all have a responsiblity to make that happen.

Conflicts of interests: the author declares the absence of conflict of interests.

For the biblilography, please consult the Italian version of the article.