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In patients with advanced heart failure, a fully magnetically levitated centrifugal-flow pump was superior to a mechanical-bearing axial-flow pump with regard to survival free of disabling stroke or reoperation to replace or remove a malfunctioning device. (Funded by Abbott; MOMENTUM 3 ClinicalTrials.gov number, NCT02224755 .).

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BACKGROUND Advanced heart failure (HF) is characterized by high morbidity and mortality. Conventional therapy may not sufficiently reduce patient suffering and maximize quality of life. OBJECTIVES . We investigated whether an interdisciplinary palliative care intervention in addition to evidence-based HF care improves certain outcomes. METHODS We randomized 150 patients with advanced HF between August 15, 2012, and June 25, 2015, to usual care (UC; n =75) or UC plus a palliative care intervention (UC+PAL; n =75) at a single center. Primary endpoints were 2 quality-of-life 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. Secondary endpoints included assessments 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. RESULTS Patients randomized to UC+PAL versus UC alone had clinically significant incremental improvement in KCCQ and FACIT-Pal scores from randomization to 6 months (KCCQ difference =9.49 points, 95% CI 0.94 to 18.05, p =0.030; FACIT-Pal difference =11.77 points, 95% CI 0.84 to 22.71, p =0.035). Depression improved in UC+PAL patients (HADS-depression difference =−1.94 points; p =0.020) versus UC-alone patients, with similar findings for anxiety (HADS-anxiety difference =−1.83 points; p =0.048). Spiritual well-being was improved in UC+PAL versus UC-alone patients (FACIT-Sp difference =3.98 points; p =0.027). Randomization to UC+PAL did not affect rehospitalization or mortality. CONCLUSIONS An interdisciplinary palliative care intervention in advanced HF patients showed consistently greater benefits in quality of life, anxiety, depression, and spiritual well-being compared with UC alone. Trial Registration ClinicalTrials.gov Identifier: NCT01589601

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