Palliative Care in Heart Failure
Key result
Palliative care improves quality of life and reduces symptom burden in heart failure.
Why the study?
Patients with HF and their families experience stress and suffering, prompting a synthesis of evidence from randomized clinical trials of palliative care interventions in HF.
Do palliative care interventions improve quality of life and reduce symptom burden in patients with heart failure?
Key Points
- To synthesize evidence from randomized clinical trials evaluating palliative care interventions in heart failure and outline models for clinical integration.
- Reviewed published randomized clinical trials of palliative care interventions among patients living with heart failure.
- Characterized models of care delivery, distinguishing between generalist primary palliative care and specialized consultative palliative care services.
- Interventions demonstrate promising improvements in patient-reported quality of life, symptom burden, and caregiver outcomes, although overall trial evidence remains in its infancy.
- Patients with heart failure experience high rates of acute service utilization in their final 30 days of life, including 64% emergency department visits, 60% hospitalizations, and 19% intensive care unit admissions.
- Integrating primary palliative care within cardiology and primary care practices enables earlier physical and emotional symptom relief and advance care planning without delaying until terminal decline.
Study Design
Type
Systematic Review
Structured PICO
Do palliative care interventions improve quality of life and reduce symptom burden in patients with heart failure?
P
Population
A systematic review of 6 randomized clinical trials evaluating palliative care interventions in patients with heart failure.
I
Intervention
Palliative care interventions (inpatient consultation, home-based, or primary palliative care)
C
Comparator
Usual care or attention control
O
Outcome
Patient-centered outcomes including quality of life, symptom burden, healthcare utilization, and mortalitypatient reported
Limitations
- Risk of bias in the majority of included trials
- Evidence base for palliative care in HF is still in its infancy
Ask about this paper
Answers are grounded in this paper and cite their sources.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Typically, these kinds of approaches have been applied mostly in malignant diseases, but I think one might reasonably argue that the prognosis of advanced heart failure is not dissimilar to that of advanced cancer, it's just that cardiologists lack the data to utilize some of these interventions.”
“Many HF clinicians recognize the importance of palliative care in the context of HF disease management. In practice, however, integrating palliative care into local HF care is challenging. This is complicated by the fact that there have previously not been consensus standards that define optimal integrated HF-palliative care, or guidance for how palliative care should be operationalized in HF management.”
“We should not be waiting until heart failure patients are eligible for hospice care - in other words truly at the end of life - to start considering palliative options. With improved education, cardiologists and primary care clinicians can integrate palliative care techniques in their everyday practice.”
Implication
Integrating palliative care into heart failure management can improve patient quality of life and symptom burden, supporting its use alongside traditional disease-modifying therapies.
Abstract
Patients with HF and their families experience stress and suffering from a variety of sources over the course of the HF experience. Palliative care is an interdisciplinary service and an overall approach to care that improves quality of life and alleviates suffering for those living with serious illness, regardless of prognosis. In this review, we synthesize the evidence from randomized clinical trials of palliative care interventions in HF. While the evidence base for palliative care in HF is promising, it is still in its infancy and requires additional high-quality, methodologically sound studies to clearly elucidate the role of palliative care for patients and families living with the burdens of HF. Yet, an increase in attention to primary palliative care (e.g., basic physical and emotional symptom management, advance care planning), provided by primary care and cardiology clinicians, may be a vehicle to address unmet palliative needs earlier and throughout the illness course.
Discussion
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Cite This Study
Kavalieratos et al. (2017) conducted a systematic review in Heart failure. Palliative care interventions vs. Usual care was evaluated. A systematic review of six randomized trials found that palliative care interventions in heart failure are associated with improved patient-centered outcomes, including symptom burden and quality of life.