Psychosocial needs and interventions for heart failure patients and families receiving palliative care support: a systematic review

Cagle, John G.; Bunting, Morgan; Kelemen, Anne; Lee, Joonyup; Terry, Dorothy; Harris, Ryan

doi:10.1007/s10741-017-9596-5

Cited by 54 publications

(42 citation statements)

References 44 publications

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“…The psychosocial-spiritual context of HF beyond depression and anxiety is understudied (25). The HF experience is rife with uncertainty, existential distress, and adjustment to modified social and professional roles.…”

Section: Natural Opportunities To Integrate Palliative Domains In Hf mentioning

confidence: 99%

Palliative Care in Heart Failure

Kavalieratos

Gelfman

Tycon

et al. 2017

Journal of the American College of Cardiology

213

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Patients with HF and their families experience stress and suffering from a variety of sources over the course of the HF experience. Palliative care is an interdisciplinary service and an overall approach to care that improves quality of life and alleviates suffering for those living with serious illness, regardless of prognosis. In this review, we synthesize the evidence from randomized clinical trials of palliative care interventions in HF. While the evidence base for palliative care in HF is promising, it is still in its infancy and requires additional high-quality, methodologically sound studies to clearly elucidate the role of palliative care for patients and families living with the burdens of HF. Yet, an increase in attention to primary palliative care (e.g., basic physical and emotional symptom management, advance care planning), provided by primary care and cardiology clinicians, may be a vehicle to address unmet palliative needs earlier and throughout the illness course.

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Section: Natural Opportunities To Integrate Palliative Domains In Hf mentioning

confidence: 99%

Palliative Care in Heart Failure

Kavalieratos

Gelfman

Tycon

et al. 2017

Journal of the American College of Cardiology

213

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“…Such research is needed because existing data are mostly based on patients with cancer that may not be generalizable to persons with a life‐limiting noncancer illness. Prognostic precision, illness trajectories, and care‐related needs differ substantially for persons with a life‐limiting noncancer diagnosis compared with persons with cancer …”

mentioning

confidence: 99%

“…Prognostic precision, illness trajectories, and care-related needs differ substantially for persons with a life-limiting noncancer diagnosis compared with persons with cancer. 22,23 Using prospective data from a nationally derived sample of decedents from the Health and Retirement Study (HRS), we sought to (1) estimate hospice use among adults 50 years or older within the United States, and (2) identify individual-level factors predicting hospice use among the general decedent population as well as within subsamples of cancer and noncancer deaths. We also describe the relationship between hospice utilization and age stratified by cause of death.…”

mentioning

confidence: 99%

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Cagle

Lee

Ornstein

et al. 2019

J American Geriatrics Society

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OBJECTIVES Reliable national estimates of hospice use and underuse are needed. Additionally, drivers of hospice use in the United States are poorly understood, especially among noncancer populations. Thus the objectives of this study were to (1) provide reliable estimates of hospice use among adults in the United States; and (2) identify factors predicting use among decedents and within subsamples of cancer and noncancer deaths. DESIGN We conducted a prospective cohort study using the Health and Retirement Study survey. Excluding sudden deaths, we used data from the 2012 survey wave to predict hospice use in general, and then separately for cancer and non‐cancer deaths. SETTING Study data were provided by a population‐based sample of older adults from the U.S. PARTICIPANTS We constructed a sample of 1,209 participants who died between the 2012 and 2014 survey waves. MEASUREMENTS Hospice utilization was reported by proxy. Exposure variables included demographics, functionality (activities of daily living [ADLs]), health, depression, dementia, advance directives, nursing home residency, and cause of death. RESULTS Hospice utilization rate was 52.4% for the sample with 70.8% for cancer deaths and 45.4% for noncancer deaths. Fully adjusted model results showed being older (odds ratio [OR] = 1.54), less healthy (OR = .79), having dementia (OR = 1.52), and having cancer (OR = 5.47) were linked to greater odds of receiving hospice. Among cancer deaths, being older (OR = 1.64) and female (OR = 2.54) were the only predictors of hospice use. Among noncancer deaths, increased age (OR = 1.58), more education (OR = 1.56), being widowed (OR = 1.55), needing help with ADLs (OR = 1.13), and poor health (OR = .77) were associated with hospice utilization. CONCLUSION Findings suggest hospice remains underutilized, especially among individuals with noncancer illness. Extrapolating results to the US population, we estimate that annually nearly a million individuals who are likely eligible for hospice die without its services. Most (84%) of these decedents have a noncancer condition. Interventions are needed to increase appropriate hospice utilization, particularly in noncancer care settings. J Am Geriatr Soc 68:783–793, 2020

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“…13 Cognitive impairment associated with heart failure is one of several issues that compound family caregivers' responsibilities. 64 Although not studied specifically in patients with heart failure, a study has shown that Alzheimer disease and related dementias increase costs through effects on the management of comorbid illnesses, which is of particular relevance for heart failure given its self-management requirements. 65 It has been documented that increasing life expectancy leads to an increasing burden of comorbid conditions in aging populations, in particular CVD and dementia.…”

Section: Special Considerations In Heart Failurementioning

confidence: 99%

“…43 Integration of informal caregiving costs into economic evaluations of illnesses such as CVD will help to avoid underinvesting for intervention strategies for these conditions. 43 For example, several studies have been designed and tested with informal caregivers of individuals with heart failure 13,[62][63][64][86][87][88][89] and stroke, [90][91][92] with some including cost analyses or estimated costs of intervention delivery. 93,94 Scientific guidelines recommend that informal caregivers be included in the care of individuals with CVD, 86,90,95 yet implementation of evidence-based strategies to support informal caregivers remains a challenge in today's healthcare system, primarily because of a lack of allocated resources within healthcare systems.…”

Section: Future Research Opportunities and Policy Implications Researmentioning

confidence: 99%

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

Dunbar¹,

Khavjou²,

Bakas³

et al. 2018

Circulation

179

102

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INTRODUCTION:In a recent report, the American Heart Association estimated that medical costs and productivity losses of cardiovascular disease (CVD) are expected to grow from $555 billion in 2015 to $1.1 trillion in 2035. Although the burden is significant, the estimate does not include the costs of family, informal, or unpaid caregiving provided to patients with CVD. In this analysis, we estimated projections of costs of informal caregiving attributable to CVD for 2015 to 2035. METHODS:We used data from the 2014 Health and Retirement Survey to estimate hours of informal caregiving for individuals with CVD by age/sex/race using a zero-inflated binomial model and controlling for sociodemographic factors and health conditions. Costs of informal caregiving were estimated separately for hypertension, coronary heart disease, heart failure, stroke, and other heart disease. We analyzed data from a nationally representative sample of 16 731 noninstitutionalized adults ≥54 years of age. The value of caregiving hours was monetized by the use of home health aide workers' wages. The per-person costs were multiplied by census population counts to estimate nation-level costs and to be consistent with other American Heart Association analyses of burden of CVD, and the costs were projected from 2015 through 2035, assuming that within each age/sex/racial group, CVD prevalence and caregiving hours remain constant. RESULTS:The costs of informal caregiving for patients with CVD were estimated to be $61 billion in 2015 and are projected to increase to $128 billion in 2035. Costs of informal caregiving of patients with stroke constitute more than half of the total costs of CVD informal caregiving ($31 billion in 2015 and $66 billion in 2035). By age, costs are the highest among those 65 to 79 years of age in 2015 but are expected to be surpassed by costs among those ≥80 years of age by 2035. Costs of informal caregiving for patients with CVD represent an additional 11% of medical and productivity costs attributable to CVD. CONCLUSIONS:The burden of informal caregiving for patients with CVD is significant; accounting for these costs increases total CVD costs to $616 billion in 2015 and $1.2 trillion in 2035. These estimates have important research and policy implications, and they may be used to guide policy development to reduce the burden of CVD on patients and their caregivers.

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Psychosocial needs and interventions for heart failure patients and families receiving palliative care support: a systematic review

Cited by 54 publications

References 44 publications

Palliative Care in Heart Failure

Palliative Care in Heart Failure

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

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