Faith P Hopp1, Robert J Zalenski2, Denise Waselewsky2, Jeri Burn3, Jessica Camp4, Robert D Welch5, Phillip Levy5. 1. School of Social Work, Wayne State University, Detroit, Michigan. Electronic address: faithhopp@wayne.edu. 2. Department of Emergency Medicine, Division of Palliative Care, Wayne State University School of Medicine, Detroit, Michigan. 3. Palliative Care Nurse Practitioner, Sinai-Grace Hospital, Detroit Medical Center, Detroit, Michigan. 4. Social Work Department, University of Michigan-Flint, Flint, Michigan. 5. Department of Emergency Medicine and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan.
Abstract
BACKGROUND:Palliative interventions are an important part of advanced heart failure (HF) care. However, these interventions are historically underutilized, particularly by African Americans. METHODS AND RESULTS: We performed a prospective randomized intervention trial in patients with advanced HF who were hospitalized for acute decompensation at 3 urban hospitals, comparing the effect of palliative care consultation (PCC) with that of usual care. The primary end point was the proportion choosing comfort-oriented care (hospice and/or "do not resuscitate" [DNR] order) 3-6 months after randomization. A total of 85 patients (mean age 68 years, 91.8% African American) were enrolled over a 2-year period. Four of the 43 patients (9.3%) randomized to the PCC group chose comfort-oriented care versus 0 of the 42 control group members (risk difference = 9.3%; 95% confidence interval = -11.8% to 30.0%). CONCLUSIONS: In this predominantly African-American cohort of hospitalized patients with advanced HF, PCC did not lead to a greater likelihood of comfort care election compared with usual care. More robust palliative interventions should be developed to meet the needs of diverse groups of patients with HF. Copyright Â
RCT Entities:
BACKGROUND: Palliative interventions are an important part of advanced heart failure (HF) care. However, these interventions are historically underutilized, particularly by African Americans. METHODS AND RESULTS: We performed a prospective randomized intervention trial in patients with advanced HF who were hospitalized for acute decompensation at 3 urban hospitals, comparing the effect of palliative care consultation (PCC) with that of usual care. The primary end point was the proportion choosing comfort-oriented care (hospice and/or "do not resuscitate" [DNR] order) 3-6 months after randomization. A total of 85 patients (mean age 68 years, 91.8% African American) were enrolled over a 2-year period. Four of the 43 patients (9.3%) randomized to the PCC group chose comfort-oriented care versus 0 of the 42 control group members (risk difference = 9.3%; 95% confidence interval = -11.8% to 30.0%). CONCLUSIONS: In this predominantly African-American cohort of hospitalized patients with advanced HF, PCC did not lead to a greater likelihood of comfort care election compared with usual care. More robust palliative interventions should be developed to meet the needs of diverse groups of patients with HF. Copyright Â
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