In this episode, Dr Kat Ralston chats with Prof Miriam Johnson about palliative care in heart failure. They discuss the evidence supporting specialist palliative care input in this patient group and explore how to develop effective integrated services. They chat about holistic, needs based assessment and share top tips on the approach to the debilitating symptom of breathlessness. Professor Miriam Johnson is Professor of Palliative Medicine at Hull York Medical School, Associate Director of the Wolfson Palliative Care Research Centre at the University of Hull. She is Adjunct Professor of Palliative Medicine at the University Technology Sydney, Sydney, Australia. For twenty years (2000 to 2020), she also provided consultant palliative physician services to Scarborough General Hospital and Saint Catherine's Hospice, Scarborough where she set up one of the UK’s first integrated palliative care services for people with heart failure. Dr Kat Ralston is a geriatric medicine registrar in Edinburgh. She is also the Education Co-Vice Chair and the joint Podcast Lead for the RCPE Trainee & Members' Committee (T&MC). Recording date: 5 December 2024 -- Useful Links -- Abel et al (2024), Hospital admissions in the last year of life of patients with heart failure, https://doi.org/10.1093/ehjqcco/qcad047. Balata et al (Oct 2024), Early integration of palliative care versus standard cardiac care for patients with heart failure (EPCHF): a multicentre, parallel, two-arm, open-label, randomised controlled trial, https://doi.org/10.1016/j.lanhl.2024.08.006. Barnes-Harris et al, Barriers and facilitators for cardiopulmonary resuscitation discussions with people with heart failure, https://doi.org/10.1371/journal.pone.0314631. Campbell et al (2018), Which patients with heart failure should receive specialist palliative care?, https://doi.org/10.1002/ejhf.1240. Date et al, Modified-release morphine or placebo for chronic breathlessness: the MABEL trial protocol, https://doi.org/10.1183/23120541.00167-2023. Ekström et al, Effect of regular low-dose extended-release morphine on chronic breathlessness in chronic obstructive pulmonary disease: the BEAMS randomized clinical trial, http://doi.org/10.1001/jama.2022.20206.  Ferreira et al, The effect of regular, low-dose, sustained-release morphine on routine physical activity in people with persistent breathlessness– a hypothesis-generating study, https://doi.org/10.1183/13993003.01484-2022. Johnson et al (2024), Benefits of specialist palliative care by identifying active ingredients of service composition, structure, and delivery model: A systematic review with meta-analysis and meta-regression, https://doi.org/10.1371/journal.pmed.1004436. Jordan et al (2020), Duration of palliative care before death in international routine practice: a systematic review and meta-analysis, https://doi.org/10.1186/s12916-020-01829-x. King et al (2022), Concurrent Validity and Prognostic Utility of the Needs Assessment Tool: Progressive Disease Heart Failure, https://doi.org/10.1016/j.jpainsymman.2022.01.014. McConnell et al (2023), Integrating palliative care and heart failure: a systematic realist synthesis (PalliatHeartSynthesis), https://doi.org/10.1136/openhrt-2023-002438. Roch et al (2020), Utility of the integrated palliative care outcome scale (IPOS): a cross-sectional study in hospitalised patients with heart failure, https://doi.org/10.1177/1474515120919386. Breathing, Thinking Functioning Model - https://www.btf.phpc.cam.ac.uk/ Caring Together - https://www.mariecurie.org.uk/professionals/working-in-partnership/caring-together Scottish Palliative Care Guidelines - https://rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/ -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://www.rcpe.ac.uk/events -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: cme@rcpe.ac.uk