Palliative Care Interventions for Patients with Heart Failure: A Systematic Review and Meta-Analysis

Abstract

Objective: To systematically characterize interventions and effectiveness of palliative care for advanced heart failure (HF) patients. Background: Patients with advanced heart failure experience a high burden of distressing symptoms and diminished quality of life. Palliative care expertise with symptom management and healthcare decision-making benefits HF patients. Methods: A systematic PubMed search was conducted from inception to June 2016 for studies of palliative care interventions for HF patients. Studies of humans with a HF diagnosis who underwent a palliative care intervention were included. Data were extracted on study design, participant characteristics, intervention components, and in three groups of outcomes: patient-centered outcomes, quality-of-death outcomes, and resource utilization. Study characteristics were examined to determine if meta-analysis was possible. Results: The fifteen identified studies varied in design (prospective, n = 10; retrospective, n = 5). Studies enrolled older patients, but greater variability was found for race, sex, and marital status. A majority of studies measuring patient-centered outcomes demonstrated improvements including quality of life and satisfaction. Quality-of-death outcomes were mixed with a majority of studies reporting clarification of care preferences, but less improvement in death at home and hospice enrollment. A meta-analysis in three studies found that homebased palliative care consults in HF patients lower the risk of rehospitalization by 42% (RR = 0.58; 95% Confidence Interval 0.44, 0.77). Discussion: Available evidence suggests that home and team-based palliative interventions for HF patients improve patient-centered outcomes, documentation of preferences, and utilization. Increased high quality studies will aid the determination of the most effective palliative care approaches for the HF population.

A Multivariable Prediction Model for Mortality in Individuals Admitted for Heart Failure

“…HF is a chronic progressive disease that limits function through increasing symptom burden. Although medical treatments may slow progression, symptom control often becomes a critical decision point toward restoring function . Geriatric co‐management improves outcomes at vulnerable times and in primary care settings .…”

“…There is an opportunity for co‐management in the high‐risk HF population. A recent systematic review on palliative care usage in individuals with HF found that interventions improve patient‐centered outcomes and documentation of treatment preferences, as well as decreasing readmissions . Within our cohort, we identified high‐ and very high‐risk groups with 1‐year mortality greater than 40%, yet palliative care was used in only approximately 3% of patients.…”

“…Although medical treatments may slow progression, symptom control often becomes a critical decision point toward restoring function. 22 Geriatric co-management improves outcomes at vulnerable times and in primary care settings. [23][24][25] Built on the interdisciplinary team structure, palliative care specialists also works collaboratively to co-manage individuals with limited life expectancy.…”

“…A recent systematic review on palliative care usage in individuals with HF found that interventions improve patient-centered outcomes and documentation of treatment preferences, as well as decreasing readmissions. 22 Within our cohort, we identified high-and very high-risk groups with 1-year mortality greater than 40%, yet palliative care was used in only approximately 3% of patients. Despite the high prevalence of HF, 1,10,26 patient and caregiver understanding of the disease is often poor, and discussions about disease progression and advanced care planning are lacking.…”

Palliative care in end-stage valvular heart disease

“…In cancer, PC has been shown to improve quality of life and, in some cases, prolong it 39–41. A recent systematic review of PC in HF cited improved quality of life and symptoms, with decreased hospitalisations and in-hospital deaths 42. Although there is not comparable literature in the population of patients with severe valve disease, 29% of the patients included in the EuroHeart study had concomitant valve disease 43…”