Timing and content of serious illness conversations for patients with advanced heart failure in a specialty-aligned palliative care service

•Patients with advanced heart failure desire conversations on values and goals.•Only 25 % of patients had a goals of care discussion prior to palliative care service.•Median time from first conversation to death was 65 days for 44 % of deceased patients.•43 % of deceased patients had multiple conversations with the palliative care team.•The “live as long as possible” option was documented for 53 % of all patients. Patients with advanced heart failure (AHF) desire communication around values and goals prior to treatment decisions. To evaluate the timing and content of the first serious illness communication (SI conversation) for patients with AHF after referral to a specialist palliative care (PC) team (HeartPal). In this retrospective cohort study, we used electronic health records to identify patients referred to HeartPal and their first SI conversations at a tertiary care hospital between October 2018 and September 2021. We used natural language processing and predetermined codes to quantify prevalence of prior goals of care conversations by the cardiology team within six months preceding the HeartPal consultation and the prevalence of hopes, fears, and seven conversation content codes. Consecutive SI conversations and patient outcomes were followed until March 2022. Of 468 patients (mean age: 64 years, 72 % male, 66 % referred for goals of care conversation), 25.2 % had prior documented goals of care conversations preceding the HeartPal consultation. During the study period, 206 (44.0 %) patients died (median time from initial SI conversation to death: 65 days, IQR 206) and 43.2 % engaged in multiple SI conversations before death. SI conversation analysis (n = 324) revealed that patients hoped to “be at home” (74.1 %, n = 240), “be independent” (65.7 %, n = 213) and “live as long as possible” (53.4 %, n = 173). Conversation content included goals of care (83.0 %), strengths (83.0 %), decision-making (79.3 %), spirituality (71.0 %), coping (52.2 %), and prognostic communication (43.5 %). Specialist PC service provides documentation of goals and values and offers longitudinal follow-up for patients with AHF.