Implementing HeartPal: Design and Early Results of a Specialized Care Delivery Model for Advancing Palliative Care in Advanced Heart Disease Populations

Nelia Jain, Division of Adult Palliative Care, Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, MA; Division of Palliative Medicine, Brigham & Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: neliajain@gmail.com.
Eilann C. Santo, Division of Adult Palliative Care, Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, MA; Division of Palliative Medicine, Brigham & Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: eilann_santo@dfci.harvard.edu.
Hanna-Riikka Lehto, Division of Adult Palliative Care, Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, MA. Electronic address: hrleht@utu.fi.
Kristen G. Schaefer, Division of Adult Palliative Care, Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, MA; Care Dimensions, Danvers, MA. Electronic address: kristen_schaefer@dfci.harvard.edu.
Katharine A. Manning, Division of Adult Palliative Care, Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, MA; Department of Cardiology, Maine Medical Center, Portland, ME; Department of Internal Medicine, Tufts University School of Medicine, Boston, MA. Electronic address: Katharine.A.Manning@hitchcock.org.
Michael J. Landzberg, Division of Adult Palliative Care, Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA. Electronic address: Mike.Landzberg@CARDIO.CHBOSTON.ORG.
Haider J. Warraich, Harvard Medical School, Boston, MA; Department of Internal Medicine, Tufts University School of Medicine, Boston, MA. Electronic address: Haider.Warraich@ARPA-H.gov.
Michael M. Givertz, Harvard Medical School, Boston, MA; Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA. Electronic address: mgivertz@bwh.harvard.edu.
Mandeep R. Mehra, Harvard Medical School, Boston, MA; Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA. Electronic address: MMEHRA@BWH.HARVARD.EDU.
James A. Tulsky, Division of Adult Palliative Care, Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, MA; Division of Palliative Medicine, Brigham & Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: JamesA_Tulsky@DFCI.HARVARD.EDU.
Akshay S. Desai, Harvard Medical School, Boston, MA; Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA. Electronic address: adesai@bwh.harvard.edu.

Document Type

Article

Publication Date

10-6-2025

Journal Title

Journal of cardiac failure

Abstract

BACKGROUND: Patients with advanced heart disease (AHD) face high symptom burden and complex care decisions with inconsistent access to palliative care (PC). We describe the design, implementation, and early outcomes of HeartPal, a specialty-aligned interprofessional PC service embedded within an AHD program, to inform replication in similar settings. METHODS: Launched in 2019, HeartPal includes a nurse practitioner, social worker, and PC physician delivering longitudinal care across inpatient and outpatient settings. We analyzed registry data from 505 patients referred between 2019-2021, fiscal year (FY) 2024 data, and service operational metrics. RESULTS: Monthly referrals increased from 13.2 to 19.3 patients (+46.2%). Referrals for advanced therapy evaluations decreased from 76/158 (48.1%) to 26/174 (14.9%), while goals-of-care referrals increased from 79/158 (50.0%) to 145/174 (83.3%). Among decedents, referrals within 60 days of death decreased by 47.1%. In-hospital deaths following index admission declined from 24 to 15 (-37.5%), and clinic follow-up increased from 23/142 (16.2%) to 34/158 (21.5%). In FY24, the team completed 837 encounters, generating 2,063 relative value units (RVUs). Billing offset 20% of direct personnel costs. CONCLUSIONS: HeartPal illustrates the feasibility of embedding PC within AHD care pathways, while highlighting the critical need for institutional investment.

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