Palliative care with home support reduced hospitalisations by 42% (OR 0.58) and 30-day readmissions by 54% (OR 0.46) in advanced heart failure patients.
Palliative care should be integrated early in advanced heart failure to address unique symptom burdens, psychosocial needs, and device deactivation, complementing standard cardiac therapies.
Effect estimate: 42% reduction in hospitalisations (OR 0.58, 95% CI 0.44–0.77); 54% reduction in 30-day readmission rates (OR 0.46, 95% CI 0.41–0.52); 73% reduction for discharge to care facilities with palliative care
Chronic heart failure (HF) is a complex clinical syndrome and a major cause of morbidity and mortality, which affects more than 64 million people worldwide. HF is associated with decreased life expectancy and is characterised by increased hospitalisations, which increase in frequency and severity as the disease progresses. Patients with advanced HF experience a poorer health status and quality of life. Advanced HF increases the risk of premature death (80% of patients die within 5 years), as well as increasing symptoms, psychosocial and spiritual burden. The trajectory of the disease is unpredictable and person-specific, influenced by a multitude of factors including age of diagnosis, ethnicity, gender, comorbidity and socioeconomic status. In advanced HF, symptom management, psychosocial support and assistance with advanced care planning are important aspects of delivering holistic care. Dyspnoea, fatigue, pain, depression, anxiety, insomnia and worsening cognitive function are frequently seen in these patients. The symptoms experienced by the patient can be caused by the HF itself, comorbidities and treatment side effects, which all require careful consideration. While many aspects of palliative care are universal, HF patients have unique needs, challenges, and opportunities. Palliative care is much less likely to be offered to patients with HF than to those with other diagnoses. In this article, we explore the rationale for improving patient access and the key opportunities and challenges for delivering high-quality palliative care in this group.
Lawless et al. (Thu,) conducted a review in Patients with advanced chronic heart failure with reduced or preserved ejection fraction experiencing frequent hospitalisations and poor quality of life. Palliative care programs with home care support vs. Standard care without palliative care intervention was evaluated on Reduction in hospitalisations and 30-day readmission rates (42% reduction in hospitalisations (OR 0.58, 95% CI 0.44–0.77); 54% reduction in 30-day readmission rates (OR 0.46, 95% CI 0.41–0.52); 73% reduction for discharge to care facilities with palliative care). Palliative care with home support reduced hospitalisations by 42% (OR 0.58) and 30-day readmissions by 54% (OR 0.46) in advanced heart failure patients.