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J Am Coll Cardiol. 2017 Jul 18;70(3):331-341. doi: 10.1016/j.jacc.2017.05.030.

Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial.

Author information

1
Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina. Electronic address: joseph.rogers@duke.edu.
2
Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
3
Duke School of Nursing, Duke University, Durham, North Carolina.
4
Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Center for Health Services Research and Development in Primary Care, Durham VA Medical Center, Durham, North Carolina.
5
Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
6
Piedmont HealthCare, Atlanta, Georgia.
7
Duke Clinical Research Institute, Durham, North Carolina.
8
Duke Clinical Research Institute, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
9
Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Sanford School of Public Policy, Duke University, Durham, North Carolina; Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina.
10
Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Inova Heart & Vascular Institute, Falls Church, Virginia.
11
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Abstract

BACKGROUND:

Advanced heart failure (HF) is characterized by high morbidity and mortality. Conventional therapy may not sufficiently reduce patient suffering and maximize quality of life.

OBJECTIVES:

The authors investigated whether an interdisciplinary palliative care intervention in addition to evidence-based HF care improves certain outcomes.

METHODS:

The authors randomized 150 patients with advanced HF between August 15, 2012, and June 25, 2015, to usual care (UC) (n = 75) or UC plus a palliative care intervention (UC + PAL) (n = 75) at a single center. Primary endpoints were 2 quality-of-life measurements, the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary and the Functional Assessment of Chronic Illness Therapy-Palliative Care scale (FACIT-Pal), assessed at 6 months. Secondary endpoints included assessments of depression and anxiety (measured via the Hospital Anxiety and Depression Scale [HADS]), spiritual well-being (measured via the FACIT-Spiritual Well-Being scale [FACIT-Sp]), hospitalizations, and mortality.

RESULTS:

Patients randomized to UC + PAL versus UC alone had clinically significant incremental improvement in KCCQ and FACIT-Pal scores from randomization to 6 months (KCCQ difference = 9.49 points, 95% confidence interval [CI]: 0.94 to 18.05, p = 0.030; FACIT-Pal difference = 11.77 points, 95% CI: 0.84 to 22.71, p = 0.035). Depression improved in UC + PAL patients (HADS-depression difference = -1.94 points; p = 0.020) versus UC-alone patients, with similar findings for anxiety (HADS-anxiety difference = -1.83 points; p = 0.048). Spiritual well-being was improved in UC + PAL versus UC-alone patients (FACIT-Sp difference = 3.98 points; p = 0.027). Randomization to UC + PAL did not affect rehospitalization or mortality.

CONCLUSIONS:

An interdisciplinary palliative care intervention in advanced HF patients showed consistently greater benefits in quality of life, anxiety, depression, and spiritual well-being compared with UC alone. (Palliative Care in Heart Failure [PAL-HF]; NCT01589601).

KEYWORDS:

heart failure; palliative care; quality of life

Comment in

PMID:
28705314
PMCID:
PMC5664956
DOI:
10.1016/j.jacc.2017.05.030
[Indexed for MEDLINE]
Free PMC Article

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