Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep;20(9):1338-1347.
doi: 10.1002/ejhf.1240. Epub 2018 Jun 28.

Which patients with heart failure should receive specialist palliative care?

Ross T Campbell  1 , Mark C Petrie  1   2 , Colette E Jackson  3 , Pardeep S Jhund  1 , Ann Wright  1 , Roy S Gardner  1   2 , Piotr Sonecki  3 , Andrea Pozzi  4 , Paula McSkimming  5 , Alex McConnachie  5 , Fiona Finlay  3 , Patricia Davidson  6 , Martin A Denvir  7 , Miriam J Johnson  8 , Karen J Hogg  9 , John J V McMurray  1
Affiliations

Which patients with heart failure should receive specialist palliative care?

Ross T Campbell et al. Eur J Heart Fail. 2018 Sep.

Abstract

Aims: We investigated which patients with heart failure (HF) should receive specialist palliative care (SPC) by first creating a definition of need for SPC in patients hospitalised with HF using patient-reported outcome measures (PROMs) and then testing this definition using the outcome of days alive and out of hospital (DAOH). We also evaluated which baseline variables predicted need for SPC and whether those with this need received SPC.

Methods and results: PROMs assessing quality of life (QoL), symptoms, and mood were administered at baseline and every 4 months. SPC need was defined as persistently severe impairment of any PROM without improvement (or severe impairment immediately preceding death). We then tested whether need for SPC, so defined, was reflected in DAOH, a measure which combines length of stay, days of hospital re-admission, and days lost due to death. Of 272 patients recruited, 74 (27%) met the definition of SPC needs. These patients lived one third fewer DAOH than those without SPC need (and less than a quarter of QoL-adjusted DAOH). A Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score of <29 identified patients who subsequently had SPC needs (area under receiver operating characteristic curve 0.78). Twenty-four per cent of patients with SPC needs actually received SPC (n = 18).

Conclusions: A quarter of patients hospitalised with HF had a need for SPC and were identified by a low KCCQ score on admission. Those with SPC need spent many fewer DAOH and their DAOH were of significantly worse quality. Very few patients with SPC needs accessed SPC services.

Keywords: Heart failure; Palliative care.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Definition of specialist palliative care (SPC) needs: persistent impairment (≥2 consecutive assessments) of any patient‐reported outcome measure (PROM) without recovery, or severe impairment of any PROM without recovery preceding death. Patient 1 did not have SPC needs as there was improvement of PROM(s) whereas there was persistent impairment without improvement in patient 3. Patient 4 has SPC needs as there was severe impairment of PROM(s) preceding death, whereas patient 2 did not have severe impairment preceding death.
Figure 2
Figure 2
Edmonton Symptom Assessment Scale: symptom distribution at baseline.
Figure 3
Figure 3
Median symptom score in patients with and without specialist palliative care (SPC) needs.
Figure 4
Figure 4
Quality of life‐adjusted, symptom‐adjusted, and mood‐adjusted days alive and out of hospital (DAOH) analysis. ESAS, Edmonton Symptom Assessment Scale; HADS, Hospital Anxiety and Depression Scale; KCCQ, Kansas City Cardiomyopathy Questionnaire; SF12, Short Form 12; SPC, specialist palliative care.
See this image and copyright information in PMC

Comment in

  • Talking about palliative care in heart failure.
    Jaarsma T, van der Wal M, Hjelmfors L, Strömberg A. Jaarsma T, et al. Eur J Heart Fail. 2018 Sep;20(9):1348-1349. doi: 10.1002/ejhf.1239. Epub 2018 Jul 2. Eur J Heart Fail. 2018. PMID: 29963736 No abstract available.

References

    1. Barnes S, Gott M, Payne S, Parker C, Seamark D, Gariballa S, Small N. Prevalence of symptoms in a community‐based sample of heart failure patients. J Pain Symptom Manage 2006;32:208–216. - PubMed
    1. Jhund PS, Macintyre K, Simpson CR, Lewsey JD, Stewart S, Redpath A, Chalmers JW, Capewell S, McMurray JJ. Long‐term trends in first hospitalization for heart failure and subsequent survival between 1986 and 2003: a population study of 5.1 million people. Circulation 2009;119:515–523. - PubMed
    1. World Health Organisation . WHO Definition of Palliative Care http://www.who.int/cancer/palliative/definition/en/ (30 January 2017)
    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González‐Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) . Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016;18:891–975. - PubMed
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;128:e240–327. - PubMed

Publication types