Palliative Care in Heart Failure
Key result
Palliative care improves 6-month KCCQ scores by ~9 points in advanced heart failure.
- MD 9.49
- 95% CI 0.94-18.05
- P=0.030
- n=150
Why the study?
Conventional therapy for advanced heart failure may not sufficiently reduce patient suffering or maximize quality of life, necessitating evaluation of palliative care interventions.
Does an interdisciplinary palliative care intervention improve quality of life in patients with advanced heart failure?
Population
150 patients with advanced heart failure at a single center
Comparison
Usual care alone vs usual care plus interdisciplinary palliative care intervention
Design
Randomized controlled trial
Follow-up
6 months
Authors
Discussion
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Member takes
Implication
Supports broader adoption of interdisciplinary palliative care in advanced HF; reinforces RCT evidence for patient-centered benefits.
Key Points
- To determine whether integrating an interdisciplinary palliative care intervention into standard heart failure therapy improves quality of life, psychological distress, and clinical outcomes.
- Single-center randomized controlled trial (PAL-HF; NCT01589601) conducted between August 15, 2012, and June 25, 2015.
- Randomized 150 patients with advanced heart failure to usual care alone (n = 75) or usual care plus an interdisciplinary palliative care intervention (n = 75).
- Evaluated primary quality-of-life endpoints at 6 months using the KCCQ overall summary and the FACIT-Pal scale, alongside secondary outcomes including depression, anxiety, spiritual well-being, rehospitalizations, and mortality.
- Patients receiving palliative care achieved statistically significant gains in KCCQ overall summary (between-group difference = 9.49 points, 95% CI: 0.94 to 18.05, p = 0.030) and FACIT-Pal scores (between-group difference = 11.77 points, 95% CI: 0.84 to 22.71, p = 0.035) at 6 months.
- Depression, anxiety, and spiritual well-being significantly improved with palliative care compared to usual care alone (HADS-depression difference = -1.94 points, p = 0.020; HADS-anxiety difference = -1.83 points, p = 0.048; FACIT-Sp difference = 3.98 points, p = 0.027).
- The addition of palliative care produced no statistically significant differences in rehospitalization rates or all-cause mortality compared to usual care alone.
Study Design
Type
RCT (n=150)
Multicenter
No
Structured PICO
Does an interdisciplinary palliative care intervention improve quality of life in patients with advanced heart failure?
P
Population
150 patients with advanced heart failure randomized to usual care with or without an interdisciplinary palliative care intervention, followed for 6 months.
I
Intervention
Interdisciplinary palliative care intervention in addition to usual care (evidence-based HF care).
C
Comparator
Usual care (evidence-based HF care) alone.
O
Outcome
2 quality-of-life measurements: the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary and the Functional Assessment of Chronic Illness Therapy-Palliative Care scale (FACIT-Pal), assessed at 6 months.patient reported
Main Result
Mean Difference: 9.49 (95% CI 0.94–18.05)
p-value: p=0.030
An interdisciplinary palliative care intervention in advanced heart failure patients provides significant benefits in quality of life, anxiety, depression, and spiritual well-being compared with usual care alone.
Cite This Study
Rogers et al. (2017) conducted an RCT in advanced heart failure (n=150). interdisciplinary palliative care intervention vs. usual care was evaluated on Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary and Functional Assessment of Chronic Illness Therapy-Palliative Care scale (FACIT-Pal) (MD 9.49, 95% CI 0.94-18.05, p=0.030). An interdisciplinary palliative care intervention added to usual care significantly improved KCCQ (MD 9.49; 95% CI 0.94-18.05; P=0.030) and FACIT-Pal scores at 6 months in advanced heart failure.