Brett R Curtis1, Bruce L Rollman2, Bea Herbeck Belnap3, Kwonho Jeong4, Lan Yu5, Matthew E Harinstein6, Dio Kavalieratos7. 1. School of Medicine, University of Pittsburgh (B.R.C., B.L.R.), Pittsburgh, Pennsylvania. 2. School of Medicine, University of Pittsburgh (B.R.C., B.L.R.), Pittsburgh, Pennsylvania; Division of General Medicine, University of Pittsburgh School of Medicine (B.L.R., B.H.B., L.Y.), Pittsburgh, Pennsylvania; University of Pittsburgh Center for Behavioral Health, Media and Technology (B.L.R., B.H.B.), Pittsburgh, Pennsylvania. 3. Division of General Medicine, University of Pittsburgh School of Medicine (B.L.R., B.H.B., L.Y.), Pittsburgh, Pennsylvania; University of Pittsburgh Center for Behavioral Health, Media and Technology (B.L.R., B.H.B.), Pittsburgh, Pennsylvania. 4. Center for Research on Health Care Data Center, University of Pittsburgh (K.J.), Pittsburgh, Pennsylvania. 5. Division of General Medicine, University of Pittsburgh School of Medicine (B.L.R., B.H.B., L.Y.), Pittsburgh, Pennsylvania. 6. Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center (M.E.H.), Pittsburgh, Pennsylvania. 7. Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University (D.K.), Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University (D.K.), Atlanta, Georgia. Electronic address: d.kavalieratos@emory.edu.
Abstract
CONTEXT: The symptom burden associated with heart failure (HF) remains high despite improvements in therapy and calls for the integration of palliative care into traditional HF care. Little is also known about how patients with HF perceive palliative care and patient-level characteristics associated with the need for palliative care, which could influence the utilization of palliative care in HF management. OBJECTIVES: To identify characteristics of HF patients associated with perceived need for palliative care. METHODS: We analyzed data from the Hopeful Heart Trial, which studied the efficacy of a collaborative care intervention for treating both systolic HF and depression. Palliative care preferences were collected during routine study follow-up. We assessed the association of perceived need for palliative care during study follow-up and baseline data on sociodemographics, clinical measures, and patient-centered outcomes. We then used descriptive statistics and logistic regression to analyze our data. RESULTS: Participants were on average 64 years old, male, and reported severe HF symptoms and poor to below average quality of life (. Most had unfavorable impressions of palliative care, but many still perceived a need for palliative care. Factors associated with perceived need for palliative care included depression, non-white race, more severe HF symptoms, and lower mental & physical health-related quality of life. CONCLUSION: HF patients' beliefs about palliative care may affect utilization of palliative care. Specific characteristics can help identify patients with HF who may benefit from palliative care involvement. Education targeted towards patients with selected attributes may help incorporate palliative care into HF management.
CONTEXT: The symptom burden associated with heart failure (HF) remains high despite improvements in therapy and calls for the integration of palliative care into traditional HF care. Little is also known about how patients with HF perceive palliative care and patient-level characteristics associated with the need for palliative care, which could influence the utilization of palliative care in HF management. OBJECTIVES: To identify characteristics of HF patients associated with perceived need for palliative care. METHODS: We analyzed data from the Hopeful Heart Trial, which studied the efficacy of a collaborative care intervention for treating both systolic HF and depression. Palliative care preferences were collected during routine study follow-up. We assessed the association of perceived need for palliative care during study follow-up and baseline data on sociodemographics, clinical measures, and patient-centered outcomes. We then used descriptive statistics and logistic regression to analyze our data. RESULTS: Participants were on average 64 years old, male, and reported severe HF symptoms and poor to below average quality of life (. Most had unfavorable impressions of palliative care, but many still perceived a need for palliative care. Factors associated with perceived need for palliative care included depression, non-white race, more severe HF symptoms, and lower mental & physical health-related quality of life. CONCLUSION: HF patients' beliefs about palliative care may affect utilization of palliative care. Specific characteristics can help identify patients with HF who may benefit from palliative care involvement. Education targeted towards patients with selected attributes may help incorporate palliative care into HF management.
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