Heart failure (HF) impacts 6.2 million American adults. With no cure, therapies aim to prevent progression and manage symptoms. Inclusion of palliative care (PC) helps improve symptoms and quality of life. Heart failure guidelines recommend the inclusion of PC in HF therapy, but referrals are often delayed.
Objective:
Introduce PC to patients with HF and examine the impact on PC consults, readmission, mortality, and intensive care unit (ICU) transfers.
Methods:
Patients (n = 60) admitted with HF to an academic hospital were asked to view a PC educational module. A number of PC consults, re-admissions, mortality, and transfers to the ICU were compared among participants and those who declined.
Results:
Nine patients in the intervention group (n = 30) requested a PC consult (P = .042) versus 2 in the usual care group (n = 30; P = .302). There was no statistically significant difference in readmissions, mortality, or ICU transfers between groups.
Conclusions:
Palliative care education increases the likelihood of PC utilization but in this short-term project was not found to statistically impact mortality, re-admissions, or transfers to higher levels of care.
BenjaminEJMuntnerPAlonosoA, et al.Heart disease and stroke statistics-2019 update: a report from the American heart association. Circulation. 2019;139(1):e56–e528.
2.
RogersJGPatelCBMentzRJ, et al.Palliative care in heart failure: The PAL-HF randomized, controlled clinical trial. J Am Coll Cardiol. 2017;70(3):331–341.
3.
McIlvennanCKAllenLA. Palliative care in patients with heart failure. BMJ. 2016;353(4):i1010.
4.
ChanHYYuDSLeungDYChanAWHuiE. Quality of life and palliative care needs of elderly patients with advanced heart failure. J Geriatr Cardiol. 2016;13(5):420–424.
5.
EvangelistaLSLiaoSMotieMDe MichelisNLombardoD. On-going palliative care enhances perceived control and patient activation and reduces symptom distress in patients with symptomatic heart failure: a pilot study. Eur J Cardiovasc Nurs. 2014;13(2):116–123.
6.
KavalieratosDKamalAHAbernethyAP, et al.Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer. J Palliat Med. 2014;17(4):475–481.
7.
LokkerMEGwytherLRileyJPvan ZuylenLvan der HeideAHardingR. The Prevalence and associated distress of physical and psychological symptoms in patients with advanced heart failure attending a South African medical center. J Cardiovasc Nurs. 2016;31(4):313–322.
8.
ShahABUdeojiDUBaraghoushABharadwajPYennurajalingamSSchwarzER. An evaluation of the prevalence and severity of pain and other symptoms in acute decompensated heart failure. J Palliat Med. 2013;16(1):87–90.
9.
BakitasMMacmartinMTrzepkowskiK, et al.Palliative care consultations for heart failure patients: how many, when, and why?J Card Fail. 2013;19(3):193–201.
10.
BrannstromMBomanK. Effects of person-centred and integrated chronic heart failure and palliative home care. PREFER: a randomized controlled study. Eur J Heart Fail. 2014;16(10):1142–1151.
11.
DiopMSRudolphJLZimmermanKMRichterMASkarfLM. Palliative care interventions for patients with heart failure: a systematic review and meta-analysis. J Palliat Med. 2017;20(1):84–92.
12.
PattendenJFMasonARLewinRJ. Collaborative palliative care for advanced heart failure: outcomes and costs from the ‘better together’ pilot study. BMJ Support Palliat Care. 2013;3(1):69–76.
13.
SahlenKGBomanKBrannstromM. A cost-effectiveness study of person-centered integrated heart failure and palliative home care: based on a randomized controlled trial. Palliat Med. 2016;30(3):296–302.
14.
SidebottomACJorgensonARichardsHKirvenJSillahA. Inpatient palliative care for patients with acute heart failure: outcomes from a randomized trial. J Palliat Med. 2015;18(2):134–142.
YancyCWJessupMBozkurtB, et al.2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart failure society of America. Circulation. 2017;136(6): e137–e161.
17.
Dionne-OdomJNKonoAFrostJ, et al.Translating and testing the ENABLE: CHF-PC concurrent palliative care model for older adults with heart failure and their family caregivers. J Palliat Med. 2014;17(9):995–1004.
WarraichHJAllenLAMukamalKJShipAKociolRD. Accuracy of physician prognosis in heart failure and lung cancer: comparison between physician estimates and model predicted survival. Palliat Med. 2016;30(7):684–689.
20.
HupceyJEKitkoLAlonsoW. Patients’ perceptions of illness severity in advanced heart failure. J Hosp Palliat Nurs. 2016;18(2):110–114.
21.
GandesberyBDobbieKGorodeskiEZ. Outpatient palliative cardiology service embedded within a heart failure clinic: experiences with an emerging model of care. Am J Hosp Palliat Care. 2018;35(4):635–639.
22.
BakitasMDionne-OdomJNPamboukianSV, et al.Engaging patients and families to create a feasible clinical trial integrating palliative and heart failure care: results of the ENABLE CHF-PC pilot clinical trial. BMC Palliat Care. 2017;16(1):45.
23.
FlintKMSchmiegeSJAllenLAFendlerTJRumsfeldJBekelmanD. Health status trajectories among outpatients with heart failure. J Pain Symptom Manage. 2017;53(2):224–231.
24.
WongFKNgAYLeePH, et al.Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial. Heart. 2016;102(14):1100–1108.
25.
NgAYMWongFKY. Effects of a home-based palliative heart failure program on quality of life, symptom burden, satisfaction and caregiver burden: a randomized controlled trial. J Pain Symptom Manage. 2018;55(1):1–11.
26.
WiskarKCeliLAWalleyKRFruhstorferCRushB. Inpatient palliative care referral and 9-month hospital readmission in patients with congestive heart failure: a linked nationwide analysis. J Intern Med. 2017;282(5):445–451.
27.
NazimADemersCBerbenetzNYouJJ. Patterns of care during the terminal hospital admission for patients with advanced heart failure: a retrospective cohort study. Can J Cardiol. 2018;34(9):1215–1218.
28.
GelfmanLPBarronYMooreS, et al.Predictors of hospice enrollment for patients with advanced heart failure and effects on health care use. JACC Heart Fail. 2018;6(9):780–789.
29.
KetelC. Potentials of internet-based patient engagement and education programs to reduce hospital readmissions: a spotlight on need in heart failure. Nurs Clin North Am. 2015;50(2):283–291.
30.
SlaterPJFieldenPEBradfordNK. The oncology family app: providing information and support for families caring for their child with cancer. J Pediatr Oncol Nurs. 2018;35(2):94–102.
31.
HansPKGrayCSGillATiessenJ. The provider perspective: investigating the effect of the electronic patient-reported outcome (ePRO) mobile application and portal on primary care provider workflow. Prim Health Care Res Dev. 2018;19(2):151–164.
32.
WangASWuJTuongWSchuppCArmstrongAW. Effectiveness of a novel interactive health care education tool on clinical outcomes and quality of life in acne patients: a randomized controlled pilot study. J Dermatolog Treat. 2015;26(5):435–439.
33.
KamalAHWolfSNicollaJM, et al.Usability of PC for Me in patients with advanced cancer referred to outpatient palliative care: results of a randomized, active-controlled pilot trial. J Pain Symp Manag. 2019;58(3):382–389.
34.
KlindtworthKOsterPHagerKKrauseOBleidornJSchneiderN. Living with and dying from advanced heart failure: understanding the needs of older patients at the end of life. BMC Geriatr. 2015;15:125.
