Purpose of review: There is a growing burden of end-stage cardiovascular disease in the aging Western world and a need to improve access to best evidence-based care, including patients located in rural areas.
Recent findings: Disparities are evident within rural settings for patients with cardiovascular disease. Useful guidelines exist to guide clinical services integration. Palliative care and cardiac services need to integrate their services defining the primary care lead with heart failure nurses coordinating. Earlier communication around disease implications, symptom burden and objectives of care feed into the integrated model for best and agreed outcomes to be achieved. Telehealth can assist a rural population when it is part of that integrated care model but more research on telemonitoring is required before conclusions can be drawn on the role of this expensive technology. Individual care plans can assist all involved. Subcutaneous furosemide may play a part in keeping a patient at home and with good palliative care the place of death can be the patient's home, if that is desired.
Summary: Rural patients with end-stage heart failure can be well supported at home as long as the model of care is united to support them. This includes heart failure nurse coordination based in the cardiac team, palliative care and general practice support.