Using Heart Failure Instruments to Determine when to Refer Heart Failure Patients to Palliative Care

Abstract

Aim: The purpose of this study was to determine whether the Edmonton Symptom Assessment Scale (ESAS) or the Palliative Performance Scale (PPS) are associated with traditionally used scores for heart failure patients — specifically, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), an overall health visual analog scale (VAS), and the Seattle Heart Failure Model (SHFM). Furthermore, we sought to determine whether the PPS or the ESAS provided additional information on quality of life, symptom severity, or prognosis above that provided by the traditional scores for patients with heart failure. Methods: We administered the ESAS, MLHFQ, VAS, PPS, and SHFM in a shuffled manner to 78 New York Heart Association Functional Classification (NYHA-FC) III-IV ambulatory heart failure patients. Pearson's r correlation was used to determine whether the scores from the ESAS and PPS correlated with the scores from the MLHFQ, VAS, and SHFM. Results: The sample was predominately male (62.8 percent), mean age 60.1 ± 13 years, with a diagnosis of idiopathic cardiomyopathy (45 percent). Moderate correlations were found between the ESAS and MLHFQ (r=0.483, p<0.01), the ESAS and VAS (r=-0.345, p<0.01), the PPS and MLHFQ (r=-0.54, p<0.01), and the PPS and VAS (r=0.53, p<0.01). There was no significant correlation between the PPS and SHFM. Conclusion: The results of this study suggest that administration of the ESAS and PPS provides additional information on symptom severity and functional decline for patients with heart failure. Standardized administration of these scales may aid in the assessment and evaluation of heart failure patients.

Palliative Care Training in Cardiology Fellowship: A National Survey of the Fellows

“…Interestingly, instruments to determine when to refer HF patients to palliative care or hospice have been studied and have correlated with palliative care scales that estimate disease severity and thus could help direct timely referral to palliative care services. 23…”

“…Interestingly, instruments to determine when to refer HF patients to palliative care or hospice have been studied and have correlated with palliative care scales that estimate disease severity and thus could help direct timely referral to palliative care services. 23 American College of Cardiology/AHA guidelines now include recommendations for assessing prognosis and prompting advanced care planning. 4,24 Despite these guidelines and the evidence for increased QOL and cost savings with early palliative care support in other terminal conditions, 25,26 only 6% to 10% of patients with HF are referred for palliative care consultation.…”

Does heart failure-specific health status identify patients with bothersome symptoms, depression, anxiety, and/or poorer spiritual well-being?

“…4,5 Previous investigators suggested that heart failure-specific health status measures be used to identify patients with heart failure who would benefit from a palliative care consultation based on symptom assessment scales and the Palliative Performance Scale. 6,7 However, these studies were small, did not identify a dichotomous heart failure-specific health status score at which clinicians should act, and did not evaluate other quality of life (QoL) domains such as depression, anxiety, or spiritual well-being. In this article, we will take a broad view of the term QoL, which the World Health Organization (WHO) defines as 'an individual's perception of their position in life in the context of the culture and values systems in which they live and in relation to their goals, expectations, standards, and concerns'.…”

A palliative approach for heart failure end-of-life care

“…However, there is very little evidence on how to operationalize this in clinical practice. In our practice, we have found it helpful to use standardized instruments to measure quality of life and symptom severity [ 23 , 24 ▪ ]. The Edmonton Symptom Assessment System (ESAS) can be used to measure symptom severity in heart failure [ 23 , 25 , 26 ].…”