Palliative care improves outcomes in advanced HF patients
Patients with advanced heart failure (HF) who undergo an interdisciplinary palliative care intervention (PAL) have consistently higher benefits in terms of quality of life (QoL), anxiety, depression and spiritual well-being compared with usual care (UC) alone, a recent study has found.
To assess whether an interdisciplinary PAL in addition to evidence-based HF care improves certain outcomes, researchers randomly assigned 150 patients with advanced HF between 15 August 2012 and 25 June 2015 to UC (n=75) or UC plus PAL (n=75) at a single centre.
Two QoL measurements, the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary and the Functional Assessment of Chronic Illness Therapy–Palliative Care scale (FACIT–Pal), assessed at 6 months were the primary endpoints.
Secondary endpoints included evaluations of depression and anxiety (measured via the Hospital Anxiety and Depression Scale [HADS]), spiritual well-being (measured via the FACIT–Spiritual Well-Being scale [FACIT–Sp]), hospitalizations and mortality.
Patients assigned to UC + PAL exhibited clinically significant incremental improvement in KCCQ and FACIT-Pal scores from randomization to 6 months compared with UC alone (KCCQ difference, 9.49 points; 95 percent CI, 0.94 to 18.05; p=0.030; PACIT‒Pal difference, 11.77; 0.84 to 22.71; p=0.035).
Both depression (HADS-depression difference, −1.94 points; p=0.020) and anxiety (HADS-anxiety difference, −1.83 points; p=0.048) improved in UC + PAL patients compared with UC-alone patients. UC + PAL patients had also improved spiritual well-being vs UC-alone patients (FACIT–Sp difference, 3.98 points; p=0.027).
Neither rehospitalization nor mortality was affected by randomization to UC + PAL.
“Advanced HF is characterized by high morbidity and mortality,” researchers said. “Conventional therapy may not sufficiently reduce patient suffering and maximize QoL.”