BACKGROUND:Heart failure (HF) is associated with a high symptom burden and reduced quality of life (QOL). Models integrating palliative care (PC) into HF care have been proposed, but limited research is available on the outcomes of such models. OBJECTIVE: Our aim was to assess if inpatient PC for HF patients is associated with improvements in symptom burden, depressive symptoms, QOL, or differential use of services. METHODS:Patients hospitalized with acute HF were randomized to receive a PC consult with follow-up as determined by provider or standard care. Two hundred thirty-two patients (116 intervention/116 control) from a large tertiary-care urban hospital were recruited over a 10-month period. Primary outcomes were symptom burden, depressive symptoms, and QOL measured at baseline, 1, and 3 months. Secondary outcomes included advance care planning (ACP), inpatient 30-day readmission, hospice use, and death. RESULTS: Improvements were greater at both 1 and 3 months in the intervention group for primary outcome summary measures after adjusting for age, gender, and marital status differences between study groups. QOL scores increased by 12.92 points in the intervention and 8 points in the control group at 1 month (difference+4.92, p<0.001). Improvement in symptom burden was 8.39 in the intervention group and 4.7 in the control group at 1 month (+3.69, p<0.001). ACP was the only secondary outcome associated with the intervention (hazard ratio [HR] 2.87, p=0.033). CONCLUSION: An inpatient PC model for patients with acute HF is associated with short-term improvement in symptom burden, QOL, and depressive symptoms.
RCT Entities:
BACKGROUND:Heart failure (HF) is associated with a high symptom burden and reduced quality of life (QOL). Models integrating palliative care (PC) into HF care have been proposed, but limited research is available on the outcomes of such models. OBJECTIVE: Our aim was to assess if inpatient PC for HF patients is associated with improvements in symptom burden, depressive symptoms, QOL, or differential use of services. METHODS:Patients hospitalized with acute HF were randomized to receive a PC consult with follow-up as determined by provider or standard care. Two hundred thirty-two patients (116 intervention/116 control) from a large tertiary-care urban hospital were recruited over a 10-month period. Primary outcomes were symptom burden, depressive symptoms, and QOL measured at baseline, 1, and 3 months. Secondary outcomes included advance care planning (ACP), inpatient 30-day readmission, hospice use, and death. RESULTS: Improvements were greater at both 1 and 3 months in the intervention group for primary outcome summary measures after adjusting for age, gender, and marital status differences between study groups. QOL scores increased by 12.92 points in the intervention and 8 points in the control group at 1 month (difference+4.92, p<0.001). Improvement in symptom burden was 8.39 in the intervention group and 4.7 in the control group at 1 month (+3.69, p<0.001). ACP was the only secondary outcome associated with the intervention (hazard ratio [HR] 2.87, p=0.033). CONCLUSION: An inpatient PC model for patients with acute HF is associated with short-term improvement in symptom burden, QOL, and depressive symptoms.
Authors: Joseph G Rogers; Chetan B Patel; Robert J Mentz; Bradi B Granger; Karen E Steinhauser; Mona Fiuzat; Patricia A Adams; Adam Speck; Kimberly S Johnson; Arun Krishnamoorthy; Hongqiu Yang; Kevin J Anstrom; Gwen C Dodson; Donald H Taylor; Jerry L Kirchner; Daniel B Mark; Christopher M O'Connor; James A Tulsky Journal: J Am Coll Cardiol Date: 2017-07-18 Impact factor: 24.094
Authors: John G Cagle; Morgan Bunting; Anne Kelemen; Joonyup Lee; Dorothy Terry; Ryan Harris Journal: Heart Fail Rev Date: 2017-09 Impact factor: 4.214
Authors: Dio Kavalieratos; Jennifer Corbelli; Di Zhang; J Nicholas Dionne-Odom; Natalie C Ernecoff; Janel Hanmer; Zachariah P Hoydich; Dara Z Ikejiani; Michele Klein-Fedyshin; Camilla Zimmermann; Sally C Morton; Robert M Arnold; Lucas Heller; Yael Schenker Journal: JAMA Date: 2016-11-22 Impact factor: 56.272
Authors: Veerawat Phongtankuel; Lauren Meador; Ronald D Adelman; Jordan Roberts; Charles R Henderson; Sonal S Mehta; Tessa Del Carmen; M C Reid Journal: Am J Hosp Palliat Care Date: 2016-11-10 Impact factor: 2.500
Authors: Natalie C Ernecoff; Devon Check; Megan Bannon; Laura C Hanson; James Nicholas Dionne-Odom; Jennifer Corbelli; Michele Klein-Fedyshin; Yael Schenker; Camilla Zimmermann; Robert M Arnold; Dio Kavalieratos Journal: J Palliat Med Date: 2019-10-23 Impact factor: 2.947
Authors: Laura P Gelfman; Dio Kavalieratos; Winifred G Teuteberg; Anuradha Lala; Nathan E Goldstein Journal: Heart Fail Rev Date: 2017-09 Impact factor: 4.214