Michelle S Diop1,2, James L Rudolph2,3,4, Kristin M Zimmerman5, Mary A Richter6, L Michal Skarf7,8. 1. 1 Primary Care and Population Medicine Program, Warren Alpert Medical School of Brown University , Providence, Rhode Island. 2. 2 Center of Innovation for Long Term Services and Supports , Providence VAMC, Providence, Rhode Island. 3. 3 Department of Medicine, Warren Alpert Medical School of Brown University , Providence, Rhode Island. 4. 4 Center for Gerontology, Brown University School of Public Health , Providence, Rhode Island. 5. 5 Department of Pharmacotherapy and Outcomes, Virginia Commonwealth University , Richmond, Virginia. 6. 6 Department of Obstetrics and Gynecology, Tulane University School of Medicine , New Orleans, Louisiana. 7. 7 Division of Geriatrics and Palliative Care, VA Boston Healthcare System , Boston, Massachusetts. 8. 8 Harvard Medical School , Boston, Massachusetts.
Abstract
OBJECTIVE: To systematically characterize interventions and effectiveness of palliative care for advanced heart failure (HF) patients. BACKGROUND: Patients with advanced heart failure experience a high burden of distressing symptoms and diminished quality of life. Palliative care expertise with symptom management and healthcare decision-making benefits HF patients. METHODS: A systematic PubMed search was conducted from inception to June 2016 for studies of palliative care interventions for HF patients. Studies of humans with a HF diagnosis who underwent a palliative care intervention were included. Data were extracted on study design, participant characteristics, intervention components, and in three groups of outcomes: patient-centered outcomes, quality-of-death outcomes, and resource utilization. Study characteristics were examined to determine if meta-analysis was possible. RESULTS: The fifteen identified studies varied in design (prospective, n = 10; retrospective, n = 5). Studies enrolled older patients, but greater variability was found for race, sex, and marital status. A majority of studies measuring patient-centered outcomes demonstrated improvements including quality of life and satisfaction. Quality-of-death outcomes were mixed with a majority of studies reporting clarification of care preferences, but less improvement in death at home and hospice enrollment. A meta-analysis in three studies found that home-based palliative care consults in HF patients lower the risk of rehospitalization by 42% (RR = 0.58; 95% Confidence Interval 0.44, 0.77). DISCUSSION: Available evidence suggests that home and team-based palliative interventions for HF patients improve patient-centered outcomes, documentation of preferences, and utilization. Increased high quality studies will aid the determination of the most effective palliative care approaches for the HF population.
OBJECTIVE: To systematically characterize interventions and effectiveness of palliative care for advanced heart failure (HF) patients. BACKGROUND:Patients with advanced heart failure experience a high burden of distressing symptoms and diminished quality of life. Palliative care expertise with symptom management and healthcare decision-making benefits HFpatients. METHODS: A systematic PubMed search was conducted from inception to June 2016 for studies of palliative care interventions for HF patients. Studies of humans with a HF diagnosis who underwent a palliative care intervention were included. Data were extracted on study design, participant characteristics, intervention components, and in three groups of outcomes: patient-centered outcomes, quality-of-death outcomes, and resource utilization. Study characteristics were examined to determine if meta-analysis was possible. RESULTS: The fifteen identified studies varied in design (prospective, n = 10; retrospective, n = 5). Studies enrolled older patients, but greater variability was found for race, sex, and marital status. A majority of studies measuring patient-centered outcomes demonstrated improvements including quality of life and satisfaction. Quality-of-death outcomes were mixed with a majority of studies reporting clarification of care preferences, but less improvement in death at home and hospice enrollment. A meta-analysis in three studies found that home-based palliative care consults in HF patients lower the risk of rehospitalization by 42% (RR = 0.58; 95% Confidence Interval 0.44, 0.77). DISCUSSION: Available evidence suggests that home and team-based palliative interventions for HF patients improve patient-centered outcomes, documentation of preferences, and utilization. Increased high quality studies will aid the determination of the most effective palliative care approaches for the HF population.
Entities:
Keywords:
cultural care; heart failure; palliative care; quality of life; symptoms; utilization
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