Patients living with heart failure receive palliative care significantly less often than patients with other illnesses, including cancer, despite evidence that such care improves symptom management and quality of life.
Those findings, made by University of Pittsburgh researchers and based on a review of existing evidence, were recently published in the Journal of the American College of Cardiology.
"We should not be waiting until heart failure patients are eligible for hospice care - in other words truly at the end of life - to start considering palliative options," said study author Dio Kavalieratos, Ph.D., director of implementation research at the UPMC Palliative & Supportive Institute and assistant professor of medicine at Pitt. "With improved education, cardiologists and primary care clinicians can integrate palliative care techniques in their everyday practice."
The researchers reviewed six palliative care intervention trials to further understand and consolidate the existing knowledge of how palliative care impacts heart failure patients. A combined 1,007 patients were included in these studies, and only trials that exclusively studied heart failure patients or reported disease-specific results were analyzed. These trials presented consistent evidence that palliative care improves patient-centered outcomes like symptom burden and quality of life.
Traditionally, trained palliative care specialists work alongside a patient's primary care team to address their palliative needs, including symptom management, complex medical decision making and long-term care discussions. The concept of primary palliative care involves all clinicians, regardless of their specialty, demonstrating competency in basic palliative skills, such as physical and emotional symptom management, and establishing treatment goals.
As patients are treated for heart failure, several important symptoms, including pain and depression, are typically undertreated, the researchers found. Addressing these symptoms with a primary palliative care approach throughout the course of treatment would reduce the likelihood that they would become overly burdensome to patients and families.
Additional research is needed to understand which palliative care models, delivery methods and treatments are most effective for patients with heart failure, noted Kavalieratos.
Additional authors on this research are Laura Tycon, M.S.N., C.R.N.P., Dara Ikejiani, B.S., and Robert Arnold, M.D., of UPMC and Pitt, Laura Gelfman, M.D., M.P.H., and Nathan Goldstein, M.D. of the Icahn School of Medicine at Mount Saini, Barbara Riegel, Ph.D., R.N., of the University of Pennsylvania School of Nursing, David Bekelman, M.D., M.P.H., of the University of Colorado School of Medicine, Stephen Kimmel, M.D., M.S.C.E., of the University of Pennsylvania Perelman School of Medicine, and Marie Bakitas, D.N.S.C., C.R.N.P., of the University of Alabama at Birmingham School of Nursing.
This research was supported by National Institutes of Health grants K01-HL133466, K23-AG049930, R01-HL102084 and R01-NR013665, and by the American Federation for Aging Research, the John A. Hartford Foundation, the National Palliative Care Research Center, Mount Sinai's Claude Pepper Older American Independence Center grant P30-AG028741 and the University of Alabama at Birmingham Centers for Comprehensive Cardiovascular Care and Palliative and Supportive Care.