People with advanced heart failure experience a poor quality of life, marked symptom burden and high mortality. With the increasing burden of disease, an aging population and limits to the availability of specialist palliative care teams to provide the necessary delivery of care, alternative models of care need to be considered.

We undertook a Systematic Review of the literature to inform the development of a Model of Care that could improve the care for people with advanced heart failure at the end of their lives, and to support the delivery of generalist palliative care for this vulnerable group of people.

Randomised controlled trials with keywords heart failure and palliative care were reviewed. Twenty-one papers were included. Salient features of care that were associated with improved quality of life and symptoms and a reduction in unplanned hospital admission include early follow-up from discharge, the intensity of the initial follow-up, coordination of care, clear communication and consistency of clinician input.

The barriers to enacting an effective palliative care approach include system issues, patient, and clinician factors.

Using Participatory Action Research and co-design between palliative care, cardiology and consumers, we are implementing a care package for people with advanced heart failure who have unmet needs. Critical to the success of this program will be identifying patients with unmet need and supporting the cardiology team to develop confidence and competence in initiating difficult conversations with people with advanced heart failure. The model of care and preliminary results will be presented at the conference.