In the public eye, palliative care is often associated with the final stage of life. In reality, however, it is far more than end-of-life care. Modern palliative care does not begin only when a disease is considered incurable and death is imminent. Rather, it aims to alleviate suffering early on, manage symptoms, and support patients and their families throughout what is often a long course of illness. This process often spans weeks or months. An international group of authors led by physicians from the University Hospital Bonn (UKB) now demonstrates in a comprehensive review that this understanding has not yet been sufficiently established, particularly in cardiovascular medicine. The study has now been published in the renowned European Heart Journal and is based on the analysis of over 1,000 scientific publications and datasets.
Cardiovascular diseases are the leading cause of death worldwide, with a higher mortality rate than many types of cancer. At the same time, their treatment has advanced significantly in recent decades. Modern medications, interventional procedures, implantable defibrillators, and mechanical cardiac support systems now enable significantly longer care for patients. Nevertheless, many affected individuals suffer for years from a high burden of symptoms, repeated hospitalizations, and complex and stressful treatment decisions.
Palliative care improves quality of life
This is where palliative care comes in. It is not intended as an alternative, but rather as a complement to cardiological therapy. The goal is to improve quality of life, alleviate symptoms such as shortness of breath, pain, fatigue, or anxiety, and make sustainable treatment decisions together with the patients. "Many people still associate palliative care exclusively with the very last phase of life," explain lead authors Endrit Cekaj, Frederik Sand, and David H. V. Vogel. "Our work, however, shows that palliative care principles should be applied much earlier so that patients can benefit from them over a long period of time."
The authors identify a lack of awareness – both among patients and in clinical practice – as a central problem. While many people underestimate the severity and mortality of cardiovascular diseases, the potential of palliative care support is often not fully utilized in medical practice. Yet early integration can not only improve the quality of life for those affected but also relieve the burden on physicians by providing structured guidance through complex decision-making processes.
The focus is on interdisciplinary collaboration and ethical issues
The review particularly emphasizes the importance of interdisciplinary collaboration. Especially in cases of advanced heart failure, repeated hospitalizations, or when deciding on invasive therapies, close coordination between cardiology, cardiac surgery, palliative care, and psychosocial and psychiatric departments is crucial. In addition to medical treatment, communication, psychosocial support, and the involvement of family members also play a central role.
At the same time, modern therapies raise new ethical questions. Life-prolonging measures such as implantable defibrillators or mechanical support systems can impose significant burdens on patients. In such situations, palliative care expertise helps balance life-prolonging measures against the patient's quality of life and tailor treatment goals to the individual.
Palliative care is often brought in too late
International studies have already shown that early palliative care can lead to better symptom management, greater satisfaction among patients and their families, and less stressful hospital stays. Nevertheless, palliative care services are often integrated into cardiology too late. "Modern cardiovascular medicine must not only prolong survival but also consistently prioritize quality of life," emphasize the last authors: Prof. Lukas Radbruch, Prof. Alexandra Philipsen, and Prof. Enzo Lüsebrink. Prof. Radbruch and Prof. Philipsen are both members of the Transdisciplinary Research Area (TRA) "Life & Health" at the University of Bonn. "The early integration of palliative care expertise can provide significant support to patients and their families during difficult phases of illness."
For clinical practice, the group of authors therefore recommends a stronger structural integration of palliative care content into cardiology. This includes interdisciplinary care teams, shared treatment models, and more intensive training in inter al communication and symptom management. Palliative care should also be given greater consideration in medical education.
The message is clear to Prof. Lüsebrink, a last author of the study, and Prof. Georg Nickenig, the Director of the Department of Cardiology at UKB. Palliative care should be the standard in cardiology, not the exception. After all, the success of sustainable cardiology will not be measured solely by how long people live, but by how well they can live.
