CARDIAC AND CIRCULATORY PROBLEMS: Edited by James M. BeattieCan a complex adaptive systems perspective support the resiliency of the heart failure patient – informal caregiver dyad?Nimmon, Lauraa; Kimel, Gilb; Lingard, Loreleid; Bates, Joannac; on behalf of the Heart Failure/Palliative Care Teamwork Research GroupAuthor Information aCentre for Health Education Scholarship, Department of Occupational Science and Occupational Therapy bSt. Paul's Hospital, Palliative Care Program, Division of Internal Medicine, Department of Medicine cCentre for Health Education Scholarship, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia dCentre for Education Research and Innovation, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada Correspondence to Dr Laura Nimmon, Scientist, Centre for Health Education Scholarship, Assistant Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, BC 429-F-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada. Tel: +1 604 822 8573; e-mail: [email protected] Current Opinion in Supportive and Palliative Care: March 2019 - Volume 13 - Issue 1 - p 9-13 doi: 10.1097/SPC.0000000000000406 Buy Metrics Abstract Purpose of review A holistic palliative approach for heart failure care emphasizes supporting nonprofessional informal caregivers. Informal caregivers play a vital role caring for heart failure patients. However, caregiving negatively affects informal caregivers’ well being, and in turn heart failure patients’ health outcomes. This opinion article proposes that complex adaptive systems (CAS) theory applied to heart failure models of care can support the resiliency of the heart failure patient – informal caregiver dyad. Recent findings Heart failure care is enacted within a complex system composed of patients, their informal caregivers and a variety of health professionals. In a national study, we employed a CAS perspective to explore how all parts of the heart failure team function interdependently in emergent and adaptive ways. Salient in our data were the severe vulnerability of elderly heart failure patients and their long-term partners who suffered from a chronic illness. Novel approaches are needed that can quickly adapt and reorganize care when unpredictable disturbances occur in the couples’ functional capacity. Summary The linear protocol-driven care models that shape heart failure guidelines, training and care delivery initiatives do not adequately capture heart failure patients’ social environment. CAS is a powerful theoretical tool that can render visible the most vulnerable members of the heart failure team, and incite robust specialized holistic palliative heart failure care models. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.