Association of Palliative Care Intervention With Health Care Use, Symptom Burden and Advance Care Planning in Adults With Heart Failure and Other Noncancer Chronic Illness

Abstract

Context: Palliative care (PC) improves outcomes in noncancer illness. We hypothesized the benefit is driven by studies of heart failure (HF) patients exclusively versus studies of other noncancer illnesses.

Objectives: To assess difference in outcomes in trials with HF patients exclusively vs studies of other noncancer chronic illness.

Methods: We performed a meta-analysis of studies that assessed association of PC with hospital admissions, emergency department (ED) visits and advance care planning in noncancer chronic illness and compared studies of HF patients versus those with other noncancer chronic illness.

Results: Our analysis included 10 HF studies (n = 4,057) and 16 non-HF studies (11 mixed conditions, 3 dementia, 2 COPD, n = 10,235). PC led to reduction in hospital admissions in HF studies (OR = 0.67 [95% CI = 0.48-0.95]) but not in other noncancer illness studies (OR = 0.86 [95% CI = 0.62-1.21]). PC intervention was nonsignificant for change in ED visits in either HF (OR = 0.70 [95% CI = 0.38-1.28]) or other noncancer studies (OR = 0.86 [95% CI = 0.69-1.07]). Increase in advance care planning was noted in both HF (OR = 4.29 [95% CI = 1.44-12.76]) and other studies (OR = 2.67 [95% CI = 1.29-5.52]). Nonsignificant reductions in symptom burden were noted for both HF-studies and non-HF studies, though overall there was a significant improvement in symptom burden (weighted mean difference -1.15 [95% CI = -1.65, -0.65]). Similar results were noted when studies of mixed populations were excluded from the non-HF studies.

Conclusion: PC is particularly effective at reducing potentially unwanted hospital admissions for patients with HF compared to other noncancer illnesses. Our findings should further encourage efforts to increase PC access to HF patients.

Keywords: Palliative care; advance care planning; chronic obstructive lung disease; dementia; health care utilization; heart failure.