Table 1.

Models for timing of palliative care consultation.

Triggers-based Modela	Using a Palliative “Transition Point”b
Deterioration despite maximum optimal multidisciplinary support Increasing fatigue and/or functional dependence Low left ventricular ejection fraction Recurrent hospitalizations Emotional distress Caregiver fatigue At the patient’s request	Recurrent decompensations within 6 months despite optimal therapy Malignant arrhythmias (ventricular tachycardia/fibrillation) Need for frequent courses of continuous IV therapy Chronic poor quality of life Intractable NYHA class IV symptoms Cardiac cachexia

^aAdapted from O’Leary N, Murphy NF, O’Loughlin C, Tiernan E, McDonald K. Eur J Heart Failure 2009; 11: 406-12.

^bAdapted from Jaarsma T, Beattie JM, Ryder et al. Eur J Heart Failure 2009; 11: 433-43.