The progressive nature of heart failure (HF) coupled with high mortality and poor quality-of-life (QoL) mandates greater attention to palliative care (PC) as a routine component of HF management. Limited evidence exists from randomized controlled trials supporting the use of interdisciplinary palliative care in the progressive course of HF. The early palliative care in heart failure trial (EPCHF) is a prospective, controlled, nonblinded, multicenter study of an interdisciplinary palliative care intervention in 200 patients with symptomatic HF characterized by NYHA ≥ 2. The 12-month EPCHF intervention includes monthly consultations by a palliative care team focusing on physical and psychosocial symptom relief, attention to spiritual concerns and advance care planning. The primary endpoint is evaluated by health-related QoL questionnaires after 12 months of treatment. First the functional assessment of chronic illness therapy palliative care (FACIT-Pal) score evaluating QoL living with a chronic disease and second the Kansas City cardiomyopathy questionnaire (KCCQ) measuring QoL living with heart failure will be determined. Secondary endpoints are changes in anxiety/depression (HADS), symptom burden score (MIDOS), spiritual well-being functional assessment of chronic illness therapy spiritual well-being scale (FACIT-Sp), medical resource and cost assessment. EPCHF will help evaluate the efficacy and cost-effectiveness of palliative care in symptomatic HF using a patient-centered outcome as well as clinical and economic endpoints. EPCHF is funded by the Bundesministerium für Bildung und Forschung (BMBF, 01GY17).
Background: Although depression symptoms are common among heart failure (HF) patients, there is little consensus regarding the relationship between depressive symptoms and NT-proBNP, the key HF marker. Therefore, this study aimed to investigate this relationship and assess the impact of depressive symptoms on the health status and clinical outcomes of HF patients. Methods: 151 patients with HF were enrolled in the study and followed up for one year. Depressive symptoms and health status were assessed by the Hospital Anxiety and Depression Scale (HADS-D) and the Kansas City Cardiomyopathy Questionnaire (KCCQ), respectively. Results: At baseline, the median HADS-D score was 5 (3 - 8) points. Patients with HADS-D scores > 5 points had significantly higher NT-proBNP levels (p = 0.043), and significantly lower KCCQ-OSS and KCCQ-CSS (p < 0.001 for both KCCQ scores). From baseline to the last assessment after one year the percentage changes in the HADS-D scores were significantly positively correlated with the percentage changes in the levels of NT-proBNP (r = 0.22, p = 0.009). It was also significantly negatively correlated with the changes in KCCQ-OSS (r = -0.34, p < 0.001) and KCCQ-CSS (r = -0.19, p = 0.021). Moreover, baseline HADS-D score was an independent predictor of the percentage changes in NT-proBNP from baseline to the last assessment (ß = 3.91, p = 0.03), even after adjustment for age, sex, baseline LVEF and creatinine (ß = 3.99, p = 0.02). In a Cox regression analysis baseline HADS-D score had a significant impact on the cardiovascular mortality, which remained consistent even after adjustment for age, sex, and baseline LVEF, NT-proBNP and creatinine (hazard ratio = 1.18, 95% CI = 1.0 – 1.4, p = 0.048). Conclusions: 1. There is a significant correlation between depressive symptoms, NT-proBNP, and health status in HF patients. 2. Baseline HADS-D score has a significant impact on the cardiovascular mortality in HF patients.
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