Sushma Datla1, Cornelia Antonia Verberkt2, Angela Hoye3, Daisy J A Janssen4,5, Miriam J Johnson6. 1. 1 University Hospitals Coventry and Warwickshire, Coventry, UK. 2. 2 Department of Health Services Research, Maastricht University, Maastricht, The Netherlands. 3. 3 Department of Academic Cardiology, Hull York Medical School, University of Hull, Hull, UK. 4. 4 Department of Research & Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands. 5. 5 Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. 6. 6 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
Abstract
BACKGROUND: Despite recommendations, people with heart failure have poor access to palliative care. AIM: To identify the evidence in relation to palliative care for people with symptomatic heart failure. DESIGN: Systematic review and narrative synthesis. (PROSPERO CRD42016029911). DATA SOURCES: Databases (Medline, Cochrane database, CINAHL, PsycINFO, HMIC, CareSearch Grey Literature), reference lists and citations were searched and experts contacted. Two independent reviewers screened titles and abstracts and retrieved papers against inclusion criteria. Data were extracted from included papers and studies were critically assessed using a risk of bias tool according to design. RESULTS: Thirteen interventional and 10 observational studies were included. Studies were heterogeneous in terms of population, intervention, comparator, outcomes and design rendering combination inappropriate. The evaluation phase studies, with lower risk of bias, using a multi-disciplinary specialist palliative care intervention showed statistically significant benefit for patient-reported outcomes (symptom burden, depression, functional status, quality of life), resource use and costs of care. Benefit was not seen in studies with a single component/discipline intervention or with higher risk of bias. Possible contamination in some studies may have caused under-estimation of effect and missing data may have introduced bias. There was no apparent effect on survival. CONCLUSION: Overall, the results support the use of multi-disciplinary palliative care in people with advanced heart failure but trials do not identify who would benefit most from specialist palliative referral. There are no sufficiently robust multi-centre evaluation phase trials to provide generalisable findings. Use of common population, intervention and outcomes in future research would allow meta-analysis.
BACKGROUND: Despite recommendations, people with heart failure have poor access to palliative care. AIM: To identify the evidence in relation to palliative care for people with symptomatic heart failure. DESIGN: Systematic review and narrative synthesis. (PROSPERO CRD42016029911). DATA SOURCES: Databases (Medline, Cochrane database, CINAHL, PsycINFO, HMIC, CareSearch Grey Literature), reference lists and citations were searched and experts contacted. Two independent reviewers screened titles and abstracts and retrieved papers against inclusion criteria. Data were extracted from included papers and studies were critically assessed using a risk of bias tool according to design. RESULTS: Thirteen interventional and 10 observational studies were included. Studies were heterogeneous in terms of population, intervention, comparator, outcomes and design rendering combination inappropriate. The evaluation phase studies, with lower risk of bias, using a multi-disciplinary specialist palliative care intervention showed statistically significant benefit for patient-reported outcomes (symptom burden, depression, functional status, quality of life), resource use and costs of care. Benefit was not seen in studies with a single component/discipline intervention or with higher risk of bias. Possible contamination in some studies may have caused under-estimation of effect and missing data may have introduced bias. There was no apparent effect on survival. CONCLUSION: Overall, the results support the use of multi-disciplinary palliative care in people with advanced heart failure but trials do not identify who would benefit most from specialist palliative referral. There are no sufficiently robust multi-centre evaluation phase trials to provide generalisable findings. Use of common population, intervention and outcomes in future research would allow meta-analysis.
Authors: Johanna Mc Broese; Albert H de Heij; Daisy Ja Janssen; Julia A Skora; Huib Am Kerstjens; Niels H Chavannes; Yvonne Engels; Rianne Mjj van der Kleij Journal: Palliat Med Date: 2020-12-18 Impact factor: 4.762
Authors: Stephanie M C Ament; Lisette M van den Broek; Marieke H J van den Beuken-van Everdingen; Josiane J J Boyne; José M C Maessen; Sebastiaan C A M Bekkers; Louise Bellersen; Hans-Peter Brunner-La Rocca; Yvonne Engels; Daisy J A Janssen Journal: BMC Palliat Care Date: 2022-01-04 Impact factor: 3.234
Authors: Daisy Ja Janssen; Stephanie Mc Ament; Josiane Boyne; Jos Mga Schols; Hans-Peter Brunner-La Rocca; José Mc Maessen; Marieke Hj van den Beuken-van Everdingen Journal: Eur J Cardiovasc Nurs Date: 2020-05-05 Impact factor: 3.908