Assessing palliative care needs in worsening heart failure patients: Insights from OPPORTUNITIES registry

Background: Worsening heart failure (WHF) patients experience frequent hospitalizations and reduced quality of life (QoL). Palliative care (PC) is recognized as essential for HF management, but its integration represent an unmet need. Objective: This study aimed to assess PC needs in WHF patients using the Palliative Care Needs Assessment Tool (PCNAT), and correlate the findings with biomarkers, clinical outcomes and prognostic scores. Methods: 144 WHF patients were prospectively evaluated at the dedicated facility in Papa Giovanni XXIII Hospital in Bergamo, Northern Italy. Patients were stratified by the highest tertile of PCNAT, identifying two groups with PCNAT≥10 or < 10. The primary outcome was the composite of all-cause mortality, HF hospitalization (HHF), emergency room (ER) visits or urgent clinical evaluation and referral to PC specialist. Results: The median follow-up was 91 days. Thirty-three percent of patients (47/144) had a PCNAT score ≥ 10. These patients had lower body mass index, worse NYHA class and more comorbidities, including chronic kidney disease, diabetes, and atrial fibrillation. They also showed worse biomarkers and lower guideline directed medical therapy use, with higher diuretic doses. Prognostic scores and QoL were significantly correlated with PCNAT score. Kaplan-Meier analysis confirmed higher clinical event rates in patients with higher PCNAT scores. Univariate and multivariate Cox regression analysis showed that PCNAT score was a significant independent predictor of clinical outcomes. Conclusion: PCNAT effectively stratifies WHF patients by PC needs, correlating with poorer clinical outcomes. Early integration of PC could improve patient-centred care, highlighting the need for systematic referral pathways.