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- Title
Palliative Care Interventions for Patients with Heart Failure: A Systematic Review and Meta-Analysis.
- Authors
Diop, Michelle S.; Rudolph, James L.; Zimmerman, Kristin M.; Richter, Mary A.; Skarf, L. Michal
- Abstract
Objective: To systematically characterize interventions and effectiveness of palliative care for advanced heart failure (HF) patients. Background: Patients with advanced heart failure experience a high burden of distressing symptoms and diminished quality of life. Palliative care expertise with symptom management and healthcare decision-making benefits HF patients. Methods: A systematic PubMed search was conducted from inception to June 2016 for studies of palliative care interventions for HF patients. Studies of humans with a HF diagnosis who underwent a palliative care intervention were included. Data were extracted on study design, participant characteristics, intervention components, and in three groups of outcomes: patient-centered outcomes, quality-of-death outcomes, and resource utilization. Study characteristics were examined to determine if meta-analysis was possible. Results: The fifteen identified studies varied in design (prospective, n = 10; retrospective, n = 5). Studies enrolled older patients, but greater variability was found for race, sex, and marital status. A majority of studies measuring patient-centered outcomes demonstrated improvements including quality of life and satisfaction. Quality-of-death outcomes were mixed with a majority of studies reporting clarification of care preferences, but less improvement in death at home and hospice enrollment. A meta-analysis in three studies found that home-based palliative care consults in HF patients lower the risk of rehospitalization by 42% (RR = 0.58; 95% Confidence Interval 0.44, 0.77). Discussion: Available evidence suggests that home and team-based palliative interventions for HF patients improve patient-centered outcomes, documentation of preferences, and utilization. Increased high quality studies will aid the determination of the most effective palliative care approaches for the HF population.
- Subjects
HEART failure treatment; CONFIDENCE intervals; PSYCHOLOGICAL distress; MEDLINE; META-analysis; ONLINE information services; PALLIATIVE treatment; PATIENT satisfaction; QUALITY of life; RESEARCH funding; SYSTEMATIC reviews; EVIDENCE-based medicine; SYMPTOMS
- Publication
Journal of Palliative Medicine, 2017, Vol 20, Issue 1, p84
- ISSN
1096-6218
- Publication type
Article
- DOI
10.1089/jpm.2016.0330