Palliative Care Intervention Improves Quality of Life in Advanced Heart Failure Patients
An interdisciplinary palliative care intervention in patients with advanced heart failure (HF) improved quality of life (QOL), anxiety, depression and spiritual well-being compared with usual care alone in the Palliative Care in Heart Failure (PAL-HF) study, published July 10 in the Journal of the American College of Cardiology.
Patients with advanced HF and a high six-month mortality risk were randomized to usual care (UC) alone or UC plus palliative care intervention (UC+PAL). The patients were followed until death or end of the study. The primary endpoints were HF-specific QOL (Kansas City Cardiomyopathy Questionnaire [KCCQ] overall summary score) and general and palliative care-specific, health-related QOL (Functional Assessment of Chronic Illness Therapy–Palliative Care scale [FACIT-Pal]).
A nurse practitioner collaborated with a palliative medicine physician and hospice to manage the intervention, in coordination with the clinical cardiology team. The nurse practitioner contacted patients in the intervention group every three months to provide ongoing support and clinical care. A cardiologist-directed team managed symptom-relief and evidence-based therapies in the UC-alone group.
The study enrolled 150 patients, equally divided between the two arms. During the six-month follow-up, 30 percent of patients were hospitalized and 29 percent died. Improvements in the KCCQ overall summary score were significantly greater in the UC+PAL group compared with the UC-alone group, with a 9.49 point difference (p = 0.030). Patients in the UC+PAL group also had greater improvement in the FACIT-Pal score (11.77 point difference; p = 0.035). Significant improvements were observed with UC+PAL vs. UC-alone for the secondary endpoints of depression (p = 0.02), anxiety (p= 0.048), and spiritual well-being (p = 0.027).
PAL-HF is the first randomized, controlled trial to show a significant clinical benefit by adding palliative care to usual care for patients with advanced HF – a finding that suggests that practitioners should consider adding palliative care to guideline-directed medical therapy for these patients, say the authors.
In a related editorial, Eric D. Adler, MD, and Nicholas Wettersten, MD, write that the PAL-HF study "highlights that all practitioners should be incorporating palliative care practices into their care of HF patients." They comment that while the study is an important step forward, there is a need for "further studies determining if there are specific interventions beneficial to the HF population, when to implement different strategies, and how to best integrate palliative care into our usual care of HF patients."
Keywords: Hospices, Palliative Care, Depression, Quality of Life, Follow-Up Studies, Physicians, Chronic Disease, Nurse Practitioners, Heart Failure, Questionnaires, Cardiomyopathies, Anxiety
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