Palliative care interventions and outcomes in patients with heart failure: an umbrella review

An expanding research base of systematic reviews has evaluated the effect of palliative care (PC) interventions delivered by primary or specialty PC providers for patients with heart failure (HF) and their caregivers. However, the overall evidence base has not been systematically examined. This umbrella review synthesizes the evidence regarding PC interventions among patients with HF to: 1) Describe interventions based on the palliative care domains in the AHA/ACC/HFSA HF guidelines, 2) Examine the effect of interventions on patient-centered and healthcare utilization outcomes, and 3) Provide recommendations for practice, policy and future research. Using the Joanna Briggs Institute methodology for umbrella reviews, we comprehensively searched for systematic reviews in MEDLINE, CINAHL, and Embase databases with no date restrictions. Published, peer-reviewed reviews were included. The search identified 19 reviews (high-quality, 11 with meta-analyses), of 104 unique primary studies after de-duplication (low to moderate quality). Primary and specialty PC was associated with improvements in quality of life, depression, advanced care planning, and reduced hospitalizations. The effect of PC on reducing symptom burden was inconclusive. Limited evidence demonstrated improvements in anxiety, satisfaction with care, caregiver burden, and hospital length of stay. PC did not significantly impact mortality rates or hospice referral. The concordance of the overall evidence was high, and although the quality of primary studies was overall low to moderate, findings confirm that primary and specialty PC offer meaningful benefits for patients with HF. Future research is required on caregiver outcomes, medically complex illness trajectories, intervention timing and fidelity, standardized outcome measurements, and longitudinal study designs with larger sample sizes.