Prevalence and characteristics of patients with heart failure needing palliative care

Abstract

Background Few hospitals and heart failure (HF) clinics offer concurrent palliative care (PC) together with life-prolonging therapies. To know the prevalence of patients in HF clinics needing PC and useful tools to recognize them are the first steps to extending PC in those settings. However, it is still unknown whether tools commonly used to identify patients with HF needing PC can correctly distinguish them. Two systematic reviews found that the NECesidades PALiativas (NECPAL) tool was one of the two most commonly used tools to asses PC needs in HF patients. Therefore, we assessed 1) the prevalence of PC needs in HF clinics according to the NECPAL tool, and 2) the characteristics of the patients identified as having PC; mainly, their quality of life (QoL), symptom burden, and psychosocial problems. Methods This cross-sectional study was conducted at two HF clinics in Colombia. We assessed the prevalence of PC in the overall sample and in subgroups according to clinical and demographic variables. We assessed QoL, symptom burden, and psychosocial problems using the 12-Item Short-Form Health Survey (SF-12), the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Edmonton Symptom Assessment System (ESAS). We compared the results of these tools between patients identified as having PC needs (+NECPAL) and patients identified as not having PC needs (–NECPAL). Results Among the 178 patients, 78 (44%) had PC needs. The prevalence of PC needs was twice as nigh in patients NYHA III/IV as in patients NYHA I/II and almost twice as high in patients older than 70 years as in patients younger than 70 years. Compared to –NECPAL patients, +NECPAL patients had worse QoL, more severe shortness of breath, tiredness, drowsiness, and pain, and more psychosocial problems. Conclusion The prevalence of PC needs in outpatient HF clinics is high and is even higher in older patients and in patients at more advanced NYHA stages. Compared to patients identified as not having PC needs, patients identified as having PC needs have worse QoL, more severe symptoms, and greater psychosocial problems. Including a PC provider in the multidisciplinary team of HF clinics may help to assess and cover these needs.

Unmet Needs in Patients With Heart Failure: The Importance of Palliative Care in a Heart Failure Clinic

“…Specifically, it is known that as the NYHA class increases, patients are at greater risk of frequent hospitalizations ( 29 ), depression ( 30 ), and poorer quality of life ( 31 , 32 ). Therefore, it is likely that the PC needs we identified become even more relevant with increasing NYHA ( 33 ). Since the majority of participants in our study where classify as NYHA II, our study could not identify the needs of patients with more advanced HF stages and thus assess the potential role of a PC provider in HF clinics in people at advanced stages.…”

“…Since the majority of participants in our study where classify as NYHA II, our study could not identify the needs of patients with more advanced HF stages and thus assess the potential role of a PC provider in HF clinics in people at advanced stages. However, the low proportion of patients classified as NYHA IV is common in ambulatory HF clinics ( 5 , 33 , 34 ), either because good pharmacological and non-pharmacological management keeps the functional class under control or because patients classified as NYHA IV despite optimal treatment are in other types of programs such as the transplant list program. Therefore, a lack of patients with a NYHA IV class should not hinder the transferability of our results to other ambulatory HF clinics.…”

Sensibilidad de escalas como pronóstico y necesidades paliativas en adultos mayores con enfermedad no oncológica.

“…Además, esta evaluación puede utilizarse como predictor de la mortalidad en pacientes con cronicidad avanzada e infección por la COVID-19 33 , y en pacientes con dos o más patologías crónicas de mal pronóstico 34 . NECPAL es una herramienta útil y factible, que agrega un criterio pronóstico al enfoque paliativo 35 y considera la evaluación pronóstica como un factor determinante para la identificación de pacientes con estas necesidades 36 .…”