Spirituality may have a positive impact on quality of life (QOL) for heart failure (HF) patients and should be considered a potential target for palliative care interventions to improve patient outcomes, according to a state-of-the-art review published March 28 in JACC: Heart Failure.

Rachel S. Tobin, MD, et al., conducted a review of 47 articles in order to explore the current knowledge of spirituality in HF patients; describe associations between spirituality and QOL, as well as patient outcomes; and propose clinical applications and future directions for spirituality in this population. There were approximately 10 varying instruments used to measure spirituality.

The researchers reference several definitions of spirituality that describe how individuals find meaning and purpose in life, which can be separate from religious beliefs. In addition, they explain that spirituality is a core domain of palliative care – which is recommended for HF patients – with the goal of identifying and addressing spiritual concerns and providing patients with appropriate spiritual and religious resources.

Of note, in the Palliative Care in Heart Failure (PAL-HF) trial, spiritual well-being improved in patients randomized to a palliative care intervention vs. usual care as evaluated by Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale. The Faith and Belief, Importance, Community, Address in Care spiritual history tool was also used to gather information on spirituality. Patients randomized to palliative care had increased QOL as measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) and Functional Assessment of Chronic Illness Therapy-Palliative Care. They were also found to have lower levels of anxiety and depression. 

Another study found that after a 12-week mail-based psychosocial intervention, patients completing the intervention had higher QOL as measured by KCCQ, as well as less depression and searching for meaning. Out of the 33 patients included, 85.7% felt that the intervention was worthwhile.

In a pilot study, spiritual counseling was associated with improved QOL, although there was no control group to determine if the effect was significant.

“The literature suggests not only can spirituality improve QOL for the patient, it can help support caregivers and potentially help HF patients from needing to be readmitted to the hospital,” Tobin said. “What we have suggested and are now doing is developing a spirituality screening tool, similar to ones used to screen for depression. This can be used to identify HF patients in palliative care who are at risk for spiritual distress. However, this is just a start. More research needs to be done.”

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Counseling, Cardiomyopathies, Chronic Disease, Anxiety, Heart Failure, Surveys and Questionnaires, Psychosocial Intervention, Caregivers, Depression, Palliative Care, Spirituality, Pilot Projects, Quality of Life

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