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.

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…”

Talking about palliative care in heart failure

“…Although heart failure differs in many aspects from cancer, it is recognized that heart failure patients have key typical palliative care needs similar to those with incurable malignant disease . A recently published review also describes that palliative care interventions that are combined with heart failure management can improve patient outcomes and decrease costs and utilization of care …”

Guidelines: friend or foe? Opportunities for improvement of cardiovascular pharmacotherapy based on evidence from real-world observational data

“…We had to deal with three very distinct breaking points of variable length, and we were not able to gather sufficient data points in all periods for a solid ITS, especially for the period after the early communication. For example, of our total study population of 39,496 patients, in August 2008, 177 patients started clopidogrel and were already using a GP drug.…”

“…In 1987 the Consensus trial 36 was published, which for the first time incontrovertibly demonstrated that the -at that time-poor outcome of patients with heart failure can be markedly improved with medical therapy. The first European guideline on the treatment of heart failure was published in 1997 37 , followed by revised guidelines in 2001 38 , 2005 39 , 2008 40 , 2012 41 and 2016. 42 In Chapter 4 we analysed in real-world data to what extent the European Society of Cardiology guidelines influenced prescription behaviour at discharge after a first hospital admission for heart failure, between 2001 and 2015.…”

“…38 Care at home with a multidisciplinary team approach for HF patients has proven to improve patientcentred outcomes. 39 A pharmacist can have a role in providing necessary medication, like intravenous diuretics in some patients or medication for palliative sedation on others, and advice on what medication might be stopped.…”