Palliative care intervention improves quality of life in patients with HF

ORLANDO, Fla. — Patients with high degree of residual symptom burden and mortality who were successfully enrolled in the Palliative Care in Heart Failure, or PAL-HF, trial had significantly improved quality of life when added to guideline-directed medical therapy, according to data presented in a late-breaking clinical trial session at the Heart Failure Society of America Scientific Assembly.

“It is well known to this audience that guideline-directed medical therapy has a favorable effect on HF morbidity/mortality, but does not address some of the emotional, psychological and spiritual concerns that are experienced by patients and their families,” Joseph G. Rogers, MD, of the Duke University Medical Center and the Duke Clinical Research Institute, said in his presentation. “Palliative care approaches that are focused on symptom relief, relief of pain and relief of some of the psychosocial factors associated with chronic illness with the goal of improving quality of life have shown to be beneficial in other life-threatening illnesses.”

The 150-patient, NIH-funded, single-center, randomized controlled clinical trial focused on a patient-centered, multidisciplinary intervention that was targeted in patients with HF at increased risk for hospitalization and mortality at 6 months.

The intervention was delivered by a nurse practitioner and focused on the relief of physical and psychological symptoms with a primary endpoint of health-related quality of life, according to the abstract. At 6 months, this endpoint was measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) and a subscale of the Functional Assessment of Chronic Illness Therapy–Palliative Care (FACIT-Pal).

Secondary endpoints of the trial included adjustments in depression, anxiety, spiritual well-being, caregiver satisfaction, resource utilization, and a composite of death, HF hospitalization and quality of life, according to the abstract.

Patients were divided into guideline-directed medical therapy (n = 75) or guideline-directed medical therapy plus palliative care intervention (n = 75) cohorts.

The mean age of the patients was 71 years (47% women; 41% black).

There was a mean HF duration of 66.9 months with an average of 2.2 hospitalizations in a 12-month period before enrollment, according to the researchers.

Nearly half of patients who underwent guideline-directed medical therapy plus palliative care (45%) showed an ejection fraction of more than 40%, and the mean baseline NT-proBNP was 11,576 pmol/L. Eighty-two percent of the patients who were sedentary more than 50% of the time rated their health as poor/fair, the researchers reported.

Although the results showed success in meeting the primary and secondary endpoints, there were some limitations to the trial, according to Rogers and colleagues.

It is unclear whether the interventions implemented in the small, single-center study trial could be replicable in other centers. The intervention was adopted in the program, which largely integrated many palliative care principles. There also was a 12% patient loss to follow-up or consent withdraw.

Regardless of these limitations, the researchers concluded that the PAL-HF trial should be used as pilot data for further research in larger, multicenter clinical trials to evaluate strategies for improvements in care. – by Dave Quaile

Reference:

Rogers J, et al. Palliative Care in HF: Results of a randomized controlled clinical trial. Presented at: Heart Failure Society of America Scientific Assembly; Sept. 17-20, 2016; Orlando, Fla.

Disclosure: Rogers reports no relevant financial disclosures.