The Palliative Care in Heart Failure Trial: Rationale and design

Abstract

Background The progressive nature of heart failure (HF) coupled with high mortality and poor quality of life mandates greater attention to palliative care as a routine component of advanced HF management. Limited evidence exists from randomized, controlled trials supporting the use of interdisciplinary palliative care in HF. Methods The Palliative Care in Heart Failure trial (PAL-HF) is a prospective, controlled, unblinded, single-center study of an interdisciplinary palliative care intervention in 200 patients with advanced HF estimated to have a high likelihood of mortality or re-hospitalization in the ensuing 6 months. The 6-month PAL-HF intervention focuses on physical and psychosocial symptom relief, attention to spiritual concerns and advanced care planning. The primary endpoint is health-related quality of life measured by the Kansas City Cardiomyopathy Questionnaire and the Functional Assessment of Chronic Illness Therapy with Palliative Care Subscale score at 6 months. Secondary endpoints include changes in anxiety/depression, spiritual well-being, caregiver satisfaction, cost and resource utilization, and a composite of death, HF hospitalization and quality of life. Conclusions PAL-HF is a randomized, controlled clinical trial that will help evaluate the efficacy and cost-effectiveness of palliative care in advanced HF using a patient-centered outcome as well as clinical and economic endpoints.

The Benefits of Palliative Care Interventions for Patients with Heart Failure - A Literature Review

“…Due to the high risk patients entered into this trial, the team expected a 50% mortality rate by the end of the 6 month study. Researchers demonstrated the need for evidence using randomized trials for palliative care interventions to identify heart failure patients that may benefit [9].…”

“…One inclusion factor was an ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization) score of ≥ 4 which indicates >50% predicted mortality within 6 months. Exclusion for this study included those who were awaiting heart transplant or who received ventricular assist devices [9].…”

“…Lessons learned, learned heritage and legacy rounded out the third session. The sessions were facilitated by a trained counselor using questions outlined in a training module [9]. Goals of care were discussed and initiated by the patient.…”

“…Some challenges they need to overcome are limited access and interventions of palliative care into heart failure treatment plans [9].…”

“…The questions assess the overall quality of life, family and patient centered care. The data collected was used to assess the estimate cost and utilization of resources for the patient care [9].…”