Palliative care and hospital readmissions in patients with advanced heart failure: Insights from the PAL-HF trial

Mentz, Robert J.; O’Connor, Christopher M.; Granger, Bradi B.; Yang, Hongqiu; Patel, Chetan B.; Fiuzat, Mona; Johnson, Kimberly S.; Anstrom, Kevin J.; Dodson, Gwen C.; Taylor, Donald H.; Mark, Daniel B.; Tulsky, James A.; Rogers, Joseph G.

doi:10.1016/j.ahj.2018.07.010

Cited by 15 publications

(20 citation statements)

References 5 publications

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“…After removing duplicate articles, our search identified 2701 articles ( Figure 1). After the title and abstract review, 39 articles were identified for full text review, and 10 independent RCTs meeting our criteria were ultimately selected, representing a total of 1050 participants [921 (87.7%) with heart failure] 15–26 …”

Section: Resultsmentioning

confidence: 99%

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The impact of palliative care on clinical and patient‐centred outcomes in patients with advanced heart failure: a systematic review of randomized controlled trials

Sahlollbey

Lee

Shirin

et al. 2020

European J of Heart Fail

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Aims To examine the impact of palliative care on acute care hospitalizations, survival, symptoms, and quality of life (QOL) in patients with advanced heart failure. Methods and results We conducted a systematic search of publications through CENTRAL, CINAHL, EMBASE, and MEDLINE originally up to July 2017, and then updated to June 2019. The study was registered (PROSPERO ID: CRD42017069685) prior to its initiation. Randomized controlled trials (RCTs) were included that tested an interdisciplinary palliative care intervention (compared to usual care) primarily in a heart failure population. Main outcomes assessed were hospitalizations, mortality, QOL, and symptom burden. Ten independent RCTs were selected, representing a total of 1050 participants (921 with a diagnosis of heart failure). Compared with usual care, palliative care interventions were associated with a substantial reduction in hospitalizations [odds ratio 0.56 (0.33–0.94); four trials; I2 = 27%], modest improvement in QOL [standardized mean difference (SMD) 0.25; 95% confidence interval (CI) 0.06–0.45; seven trials; I2 = 15%], and modest reduction in symptom burden (SMD −0.29; 95% CI −0.54–0.03; three trials; I2 = 15%). There was no clear adverse impact on mortality. Most studies had methodological limitations that increased the risk of biases. Conclusion Compared to usual care, palliative care interventions substantially reduce hospitalizations, with no clear adverse effect on survival. Effects on QOL and symptom burden appear to be modest, and indicate that further efforts to improve these patient centred outcomes are needed.

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Section: Resultsmentioning

confidence: 99%

“…After the title and abstract review, 39 articles were identified for full text review, and 10 independent RCTs meeting our criteria were ultimately selected, representing a total of 1050 participants [921 (87.7%) with heart failure]. [15][16][17][18][19][20][21][22][23][24][25][26]…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

The impact of palliative care on clinical and patient‐centred outcomes in patients with advanced heart failure: a systematic review of randomized controlled trials

Sahlollbey

Lee

Shirin

et al. 2020

European J of Heart Fail

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“…The sample sizes of included studies ranged from 11 [ 52 ] to 392 [ 36 ]. The setting for care delivery varied across the studies, encompassing the full range of potential sites for palliative care delivery: community ( n = 4) [ 35 , 49 – 51 ], outpatients ( n = 6) [ 37 , 39 , 42 , 43 , 46 , 52 ], hospital (n = 1) [ 38 ], and across mixed settings ( n = 7) [ 36 , 40 , 41 , 44 , 45 , 47 , 48 ]. Table 1 summarises the key study characteristics of each included study.…”

Section: Resultsmentioning

confidence: 99%

“…No significant difference between groups. Mentz et al [ 39 ] USA *Note: same population/ intervention as Rogers et al* RCT Outpatient consultations N = 75 Mean Age (SD) = 71.9 (12.4) Sex: M 42 (56%); F 33 (44%) NYHA Class III 54 (72%) NYHA Class IV 15 (20%) LVEF: Normal > 55% 21 (28%), 40–55% 14 (18.7%), 25–40% 17 (22.7%), < 25% 23 (30.7%) N = 75 Mean Age (SD) = 69.8 (13.4) Sex: M 37 (49.3%); F 38 (50.7%) NYHA Class III 58 (77.3%) NYHA Class IV 5 (6.7%) LVEF: Normal > 55% 14 (18.7%), 40–55% 19 (25.3%), 25–40% 14 (18.7%), < 25% 28 (37.3%) Intervention PAL-HF: interdisciplinary, multicomponent palliative care intervention. PC nurse practitioner coordinated patient’s care in collaboration with palliative care physician and the cardiology team.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness and cost effectiveness of palliative care interventions in people with chronic heart failure and their caregivers: a systematic review

et al. 2022

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Background Chronic heart failure is a common condition, and its prevalence is expected to rise significantly over the next two decades. Research demonstrates the increasing multidimensional needs of patients and caregivers. However, access to palliative care services for this population has remained poor. This systematic review was to provide an evidence synthesis of the effectiveness and cost-effectiveness of palliative care interventions for people with chronic heart failure and their caregivers. Methods Relevant publications were identified via electronic searches of MEDLINE, Embase, PsychInfo, CINAHL, CENTRAL and HMIC from inception to June 2019. Grey literature databases, reference list, and citations of key review articles were also searched. Quality was assessed using the Revised Cochrane Risk of Bias Tool. Results Of the 2083 records, 18 studies were identified including 17 having randomised controlled trial (RCT) designs and one mixed methods study with an RCT component. There was significant heterogeneity in study settings, control groups, interventions delivered, and outcome measures used. The most commonly assessed outcome measures were functional status (n = 9), psychological symptoms (n = 9), disease-specific quality of life (n = 9), and physical symptom control (n = 8). The outcome measures with the greatest evidence for benefit included general and disease-specific quality of life, psychological symptom control, satisfaction with care, physical symptom control, medical utilisation, and caregiver burden. Moreover, the methodological quality of these studies was mixed, with only four having an overall low risk of bias and the remaining studies either demonstrating high risk of bias (n = 10) or showing some concerns (n = 4) due to small sample sizes and poor retention. Only two studies reported on economic costs. Both found statistically significant results showing the intervention group to be more cost effective than the control group, but the quality of both studies was at high risk of bias. Conclusions This review supports the role of palliative care interventions in patients with chronic heart failure and their caregivers across various outcomes, particularly quality of life and psychological wellbeing. Due to the highly heterogeneous nature of palliative care interventions, it is not possible to provide definitive recommendations as to what guise palliative care interventions should take to best support the complex care of this population. Considerable future research, particularly focusing on quality of care after death and the caregiver population, is warranted.

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“…28 Only a few small studies with mixed findings regarding the effect on proximal patient-centered outcomes such as quality of life are available. None of the heart failure palliative care studies [29][30][31] thus far have been powered to detect reductions in use of acute care services. Interestingly, the PACT-HF study, 8 which was not framed as a palliative care intervention but had many palliative care elements, reported significant improvements in measures such as perception of discharge preparedness, quality of care transition, and quality of life, although there were no reductions in use of services.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Transitional Care Program After Hospitalization for Heart Failure in an Integrated Health Care System

et al. 2020

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IMPORTANCEPrompted by null findings from several care transition trials and practice changes for heart failure in recent years, leaders from a large integrated health care system aimed to reassess the outcomes of its 10-year multicomponent transitional care program for heart failure (HF-TCP).OBJECTIVE To examine the association of the individual HF-TCP components and their bundle with the primary outcome of all-cause 30-day inpatient or observation stay readmissions.

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Palliative care and hospital readmissions in patients with advanced heart failure: Insights from the PAL-HF trial

Cited by 15 publications

References 5 publications

The impact of palliative care on clinical and patient‐centred outcomes in patients with advanced heart failure: a systematic review of randomized controlled trials

The impact of palliative care on clinical and patient‐centred outcomes in patients with advanced heart failure: a systematic review of randomized controlled trials

Effectiveness and cost effectiveness of palliative care interventions in people with chronic heart failure and their caregivers: a systematic review

Evaluation of a Transitional Care Program After Hospitalization for Heart Failure in an Integrated Health Care System

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