Advanced clinical practitioner-led palliative care heart failure model within the National Health Service: a prospective study of patient experience, healthcare costs, and end-of-life outcomes

AIMS: Despite growing evidence of palliative care (PC) benefits in heart failure (HF), its integration into standard practice remains limited across the UK. Patients with advanced HF often experience poor quality of life (QoL), recurrent hospitalizations, and fragmented care. This study evaluated the impact of a guideline-informed, Heart Failure Advanced Clinical Practitioner (HFACP)-led palliative HF model incorporating telehealth on QoL, healthcare utilization, costs, and end-of-life outcomes. METHODS AND RESULTS: This prospective mixed-methods cohort study (March 2023-March 2025) followed 100 patients with advanced HF receiving home-based PC interventions over 6 months. Primary outcomes included QoL [Kansas City Cardiomyopathy Questionnaire (KCCQ-23) and EuroQoL 5-Dimension 5-Level (EQ-5D-5L)], healthcare cost savings, advance care planning (ACP) uptake, and preferred place of death. Patient satisfaction was assessed at 3 months. Among 100 patients (mean age 76 ± 13, 60% male), 81 completed ACP discussions. Of 54 eligible patients for telehealth, only 29% participated. Mean EQ-5D-5L scores declined from baseline to 6 months (0.38 to 0.30), while KCCQ-23 scores decreased from 37.8 to 33.3. Despite this, 93% rated their care positively. KCCQ summary scores < 45 were associated with increased 1-year mortality, HF admissions, and healthcare use. Of 26 deaths, 11 (42.3%) occurred at home, aligning with patient preferences. Hospital avoidance interventions generated estimated savings of £672 743.50 over the 2-year study period. CONCLUSION: The HFACP-led model achieved high patient satisfaction, increased ACP engagement, and substantial cost savings. However, declining QoL scores and limited telehealth suggest opportunities for targeted strategies, including earlier referral to PC services. Low KCCQ may identify patients with limited survival requiring timely palliative interventions.