Acute heart failure (AHF) is a significant global health burden, affecting 26 million individuals worldwide.1 Heart failure (HF) guidelines recommend initiation and early uptitration of guideline-directed medical therapy (GDMT) before discharge in patients with AHF.2–4 Sacubitril/valsartan (Sac/Val) with full uptitration, which is one of the GDMTs, reduces N-terminal pro-B-type natriuretic peptide (NT-proBNP), HF hospitalization, and all-cause death in AHF patients.5–7 However, uptitration of Sac/Val has a risk of drug discontinuation in specific patients with tolerability because it may cause some adverse events, including hypotension, hyperkalaemia, and worsening kidney function.

Heart failure (HF) remains a major public health challenge due to its high prevalence, significant morbidity, substantial and rising mortality rates, and considerable economic impact (1). Despite several advancements in guideline-directed medical therapy (GDMT) for HF, approximately 6.7 million Americans live with HF, with an increase to 8.5 million expected by 2030 (2–4). This is due both to the advancing age of the population as well as a rise in the lifetime risk of developing HF to 24% (5,6).

Clinical practice guidelines for the management of heart failure (HF) strongly recommend palliative care for assistance with the symptoms, quality of life and medical decision making associated with advanced disease.1 However, access to specialist palliative care (SPC) in this population remains markedly low, with less than 20% of people with advanced HF receiving SPC services.2,3 Nationally, SPC is provided primarily to people with HF within inpatient settings. This contrasts with SPC delivery among people with cancer, a population who share a similar symptom burden,4 where 95% of cancer centers in the United States provide ambulatory SPC.