Palliative care consultation may benefit heart failure patients

Symptomatic heart failure (HF) patients experience a high prevalence of pain and symptom burden akin to the experiences of cancer patients, say researchers, who report that a palliative care (PC) consultation in this population could reduce these factors.

Indeed, the PC consultation they introduced for analysis was not only feasible but resulted in reduced symptom burden and depression, and improved quality of life (QoL) among a cohort of 36 HF patients.

"These findings substantiate earlier research findings that outpatient PC referrals early in the disease trajectory enhance clinical management and care coordination for patients and families suffering with the burden of HF," write Lorraine Evangelista (University of California, Irving, USA) and co-workers in the Journal of Cardiac Failure.

The team identified 36 adult patients treated at a university-affiliated medical center between March and July 2008 for an acute HF exacerbation, and carried out the PC consult, which included clinical and psychologic assessments for distress, QoL, and symptoms of pain, nausea, and anxiety.

Data were compared with those for 36 patients hospitalized for HF exacerbation at another institution who received standard HF care.

All participants completed a survey before and 3 months after the time of the PC consult.

Both groups of patients reported significantly lower levels of symptom burden and depression, and improved emotional health and overall QoL at the 3-month follow up. For example, symptom burden (measured on the Edmonton Symptom Assessment Scale) decreased from 37.1 to 30.9 in the PC consult group and from 37.3 to 34.0 in the standard care group.

By contrast, physical health improved for patients who had received the PC consult, with Minnesota Living With Heart Failure Questionnaire scores falling from 15.6 to 13.8, but worsened among those who received standard care, with scores increasing from 16.3 to 18.9.

Patients' baseline symptom burden, depression, and QoL scores, as well as whether they underwent the PC consult or not accounted for 57% of the variance in symptom burden at the 3-month follow up, remark Evangelista et al. The same factors accounted for 23% of the variance in depression at follow up, they add.

Furthermore, adjusting data for gender and comorbidity accounted for 75%, 37%, and 50% of the variance in physical health, emotional health, and overall QoL, respectively.

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