Beyond Prolonging Life: The Role of Palliative Care in Cardiology

June 22, 2026
Author: Diego Aguirre-Villegas
Versión en Español

Introduction

Contemporary cardiology has achieved significant therapeutic advances capable of prolonging survival and modifying the natural course of multiple cardiovascular diseases. However, in patients with advanced heart failure, a fundamental question often arises: how far should we treat, and when should we truly begin to care for the patient?

Development

For decades, the palliative care approach has been associated almost exclusively with oncology patients or terminal scenarios. However, cardiovascular diseases such as advanced heart failure currently represent one of the main causes of functional decline, recurrent hospitalization, and physical and emotional suffering in the adult population (1-3). In Mexico, where cardiovascular diseases continue to be the main cause of mortality, the debate over quality of life, human dignity, and therapeutic limits undoubtedly arises, acquiring increasing bioethical relevance (4).

Cardiology today has highly sophisticated guidelines and diagnostic and therapeutic tools, such as ventricular assist devices, implantable defibrillators, advanced pharmacological therapies, and structural interventions capable of significantly modifying prognosis. However, technological progress has also brought new ethical dilemmas, where the possibility of intervening does not always necessarily imply the moral obligation to do so in every scenario (3,5,6).

In many patients with advanced heart failure, disabling symptoms persist, such as dyspnea, fatigue, anxiety, pain, and progressive deterioration of autonomy, even under adequate medical management and guideline-based treatment. It has been shown that the symptom burden and impact on quality of life in these patients can be comparable to those observed in advanced oncological diseases, which justifies the early incorporation of palliative strategies within the comprehensive management of the patient (1,6,7). In this context, palliative care does not represent therapeutic abandonment, but rather a complementary modality of person-centered care aimed at relieving suffering and improving quality of life through the identification and approach of the physical, psychological, social, and spiritual needs of both the patient and the entire family (1,6). This approach, in turn, promotes shared decision-making, advanced care planning, and the adaptation of therapeutic interventions according to the individual values and goals of each patient (1,6,7).

From a bioethical standpoint, integrating palliative care in cardiology means recognizing and applying fundamental principles such as beneficence, non-maleficence, and autonomy. In patients with advanced cardiovascular disease, prolonging life through increasingly invasive interventions has been observed not always to translate into a clinically significant benefit and, under certain circumstances, may increase the severity of symptoms, suffering, and, in turn, the loss of quality of life (1,6,8). This reality compels reflection on the concept of therapeutic obstinacy or medical futility, understood as the use of disproportionate diagnostic or therapeutic measures when the probability of achieving outcomes relevant to the patient is minimal or practically nonexistent (8,9).

Likewise, the principle of autonomy takes on central relevance in the care of people with advanced heart failure, where it has been observed that many patients are unaware of the real prognosis of their disease or do not participate in a timely manner in conversations related to their therapeutic goals, end-of-life preferences, and advance care planning (2,5,6). In this sense, palliative medicine promotes spaces for open, honest, and compassionate communication, favoring shared decision-making and allowing treatments to align with the values, wishes, and priorities of each individual and their family (2,6).

Furthermore, it is essential to understand that the suffering associated with advanced cardiovascular disease transcends the physical dimension. In addition to symptoms such as dyspnea, pain, or fatigue, these patients frequently experience anxiety, depression, uncertainty about the future, loss of functional independence, and a significant emotional, family, social, and economic burden (6,10). This phenomenon has been described as “total suffering,” a concept widely recognized in palliative medicine that requires a multidimensional approach (10,11).

In this context, the early integration of palliative care within cardiovascular management offers a person-centered model of care, oriented not only toward symptom control but also toward emotional accompaniment, support for families, psychological care, and, when the patient so wishes, spiritual support. In this way, palliative care complements conventional cardiological treatment and contributes to improving quality of life, satisfaction with the care received, and the concordance between medical decisions and the personal goals of each person (2,6,8,10).

It is estimated that 6.3% of deaths in Latin America are directly associated with heart failure; therefore, one of the main challenges in caring for these patients currently consists of identifying, in a timely manner, those who could benefit from a palliative approach. This is because, unlike many malignant neoplasms, whose clinical trajectory usually presents a relatively predictable terminal phase, heart failure is characterized by a fluctuating course that is difficult to anticipate or predict, marked by periods of clinical stability interspersed with episodes of acute decompensation that can compromise the patient’s life (5,6,12,13).

This prognostic uncertainty contributes to palliative care frequently being incorporated in very advanced stages of the disease, in parallel with medical treatment, limiting the opportunities to optimize symptom control, advance care planning, and the comprehensive accompaniment of the patient and family, an approach supported by current evidence (2,6,7,12).

In this context, contemporary medicine faces the challenge of harmonizing the extraordinary technological advances with the fundamental principles of human care, since the availability of an intervention does not necessarily imply the ethical obligation to use it in all cases. Therefore, it is essential to remember that the purpose of medicine does not consist solely of prolonging biological survival, but also of relieving suffering, preserving dignity, and promoting the best possible quality of life for each patient (2,6,14).

From this perspective, palliative care represents a natural extension of comprehensive cardiovascular care, where, far from opposing treatments aimed at modifying the disease, it complements them through an approach centered on the needs and preferences of the person, contributing to a more humane and ethical medical practice consistent with the fundamental values of the profession (2,5,6,7).

Conclusions

The integration of palliative care in cardiology today constitutes a clinical, ethical, and human necessity. Recognizing that there are patients whose disease will continue to progress despite the available therapeutic advances does not represent a failure of medicine, but rather an opportunity to redefine the goals of care and orient attention toward what is truly meaningful for the person and their quality of life (2,6,7).

Bioethics provides fundamental tools to reflect on therapeutic proportionality, patient autonomy, beneficence, non-maleficence, and respect for human dignity in scenarios of advanced disease (8). From this perspective, palliative care complements and integrates conventional cardiovascular treatment, promoting the relief of suffering and shared decision-making in accordance with each patient's values and preferences (2,6,7).

Contemporary medicine constantly faces the risk of equating clinical success exclusively with the adoption of new technologies or the prolongation of survival. However, the evidence and ethical principles indicate that extending life without considering suffering, functionality, quality of life, or the patient’s wishes can distance medical practice from its fundamental purpose: to care comprehensively for the human being (2,7,8,11).

In cardiology, where technological innovation continues to transform the prognosis of multiple diseases, it is essential to maintain a humanistic vision capable of balancing science, ethics, and compassion. To care also means to accompany, to relieve symptoms, to communicate honestly, to respect autonomy, and to recognize the limits of medicine when necessary, since, more than deciding between treating or not treating, the true challenge consists of determining how to treat in an ethical, proportionate manner centered on the dignity of the human person (2,6,7,8,11).

Referencias

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Diego Aguirre Villegas is the founder and president of the University Chapter of the American College of Cardiology (ACC) at Universidad Anáhuac México, as well as president of the Regulatory Committee of the Medical Specialty Interest Groups. He is currently pursuing the Medical Surgeon degree (Licenciatura en Médico Cirujano) and participates in various academic and research projects focused on clinical cardiology, cardiovascular prevention, and student training. 

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Declaration on the use of artificial intelligence: During the preparation of this article, artificial intelligence was used as a support tool for style correction, writing, and content organization. The intellectual authorship, critical review, and final content correspond exclusively to the author.