Helping Advanced Heart-Failure Patients Through Palliative Care

Summary and Comment |
August 1, 2017

Helping Advanced Heart-Failure Patients Through Palliative Care

  1. Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Provocative findings of improved quality of life and coping

  1. Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Advanced heart failure (HF) is similar to advanced malignancies with respect to its impact on quality of life and survival. Palliative care is a mainstay in oncology, with studies demonstrating improved quality of life, lower costs, and perhaps prolonged life expectancy. Although American College of Cardiology/American Heart Association guidelines strongly recommend palliative care for selected patients with advanced HF, the recommendation is not based upon evidence from clinical trials.

This single-center study of palliative care enrolled 150 hospitalized or recently hospitalized patients with advanced HF and high predicted 30-day mortality (mean age, 71; 47% women; 45% with left ventricular ejection fraction >40%). Participants were randomized to usual care alone directed by a HF specialist or usual care plus an interdisciplinary palliative-care intervention. The intervention, provided by a certified palliative-care nurse practitioner and a board-certified palliative-care physician, focused on goal setting and amelioration of symptoms.

After 6 months of follow-up, the intervention was associated with significantly greater, clinically important improvements in quality of life and with improvements in depression, anxiety, and spiritual well-being. The groups did not differ in mortality or hospitalization rates.

Comment

Randomized trials of interventions to enhance quality of life in patients with advanced cardiovascular disease are rare. Despite the study's limitations (small size, single center, lack of blinding, and high dropout), its findings support the value of interdisciplinary palliative interventions in advanced HF even when a HF specialist delivers the “usual care.” However, the intervention is likely infeasible for large-scale implementation due to its resource requirements and the limited availability of palliative care specialists, at least so long as payers do not reward improving patients' quality of life. A question meriting further study is whether a typical HF care team without specialized palliative training could produce similar benefits with components of the intervention.

Editor Disclosures at Time of Publication

  • Disclosures for Frederick A. Masoudi, MD, MSPH, FACC, FAHA at time of publication Grant / Research support National Heart, Lung, and Blood Institute; American College of Cardiology; Patient-Centered Outcomes Research Institute; John. A. Hartford Foundation Editorial boards UpToDate Leadership positions in professional societies American College of Cardiology (Chief Science Officer, National Cardiovascular Data Registries; Member, Board of Trustees); American Heart Association (Immediate Past Chair, Council on Quality of Care and Outcomes Research); American Board of Internal Medicine (Member, Cardiology Board)

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.