Does the Type and Frequency of Palliative Care Services Received by Patients with Advanced Heart Failure Impact Symptom Burden?

Evangelista, Lorraine S.; Liao, Solomon; Motie, Marjan; Michelis, Nathalie De; Ballard-Hernandez, Jennifer; Lombardo, Dawn

doi:10.1089/jpm.2013.0231

Cited by 27 publications

(23 citation statements)

References 15 publications

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“…PROMs were categorised according to severity. The derivation and testing of these PROMs in HF (as well as definitions of severity where available) are described in Table …”

Section: Methodsmentioning

confidence: 99%

Which patients with heart failure should receive specialist palliative care?

Campbell

Petrie

Jackson

et al. 2018

European J of Heart Fail

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“…PROMs were categorised according to severity. The derivation and testing of these PROMs in HF (as well as definitions of severity where available) are described in Table …”

Section: Methodsmentioning

confidence: 99%

Which patients with heart failure should receive specialist palliative care?

Campbell

Petrie

Jackson

et al. 2018

European J of Heart Fail

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“…(183–185) Multiple studies have shown that co-managed patients experience a decrease in symptoms such as pain, depression, and fatigue, which often recur shortly after the discontinuation of palliative care follow-up. (186,187) Co-management between cardiology and palliative care also allows patients to continue all beneficial cardiac medications and treatments while receiving medication for symptom palliation at the same time. (188) Ongoing studies are further evaluating the effect of palliative care on clinical and economic endpoints in advanced HF.…”

Section: Collaborative Management and A Call To Actionmentioning

confidence: 99%

Symptom burden in heart failure: assessment, impact on outcomes, and management

et al. 2016

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Evidence-based management has improved long-term survival in patients with heart failure (HF). However, an unintended consequence of increased longevity is that patients with HF are exposed to a greater symptom burden over time. In addition to classic symptoms such as dyspnea and edema, patients with HF frequently suffer additional symptoms such as pain, depression, gastrointestinal distress, and fatigue. In addition to obvious effects on quality of life, untreated symptoms increase clinical events including emergency department visits, hospitalizations, and long-term mortality in a dose-dependent fashion. Symptom management in patients with HF consists of two key components: comprehensive symptom assessment and sufficient knowledge of available approaches to alleviate the symptoms. Successful treatment addresses not just the physical but also the emotional, social, and spiritual aspects of suffering. Despite a lack of formal experience during cardiovascular training, symptom management in HF can be learned and implemented effectively by cardiology providers. Co-management with palliative medicine specialists can add significant value across the spectrum and throughout the course of HF.

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“…16,20–22 Instead of palliative care, patients at end-of-life often receive intensive and costly care even when it may not contribute significantly to prolonging life. 12 Lack of GoC communication in advanced HF results in slow progression towards death with high symptom burden 23,24 and decreased quality of life, 25,26 increased length of stay in inpatient and intensive care units, and increased costs of care near the end of life. 5,27 Therefore, the purpose of the study was to determine if an intervention designed to assist patients in initiating GoC conversations with HF providers would result in increased numbers of GoC conversations, improved quality of communication with HF health care providers, referrals to palliative care services and completion of advance directives.…”

Section: Introductionmentioning

confidence: 99%

An Intervention to Enhance Goals-of-Care Communication Between Heart Failure Patients and Heart Failure Providers

Doorenbos

Levy

Curtis

et al. 2016

Journal of Pain and Symptom Management

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Context Heart failure patients contend with a markedly impaired quality of life, experiencing emotional distress and severe physical discomfort that increases in frequency in the last months of life. Improving communication between patients and providers about goals of care has the potential to improve patient-provider communication and patient outcomes. Objectives To determine the effects of a goals-of-care (GoC) intervention compared to usual care on the number of GoC conversations, quality of communication between patients and providers, referrals to palliative care services and completion of advance care directives. Methods A two-group randomized study (n = 40/group) compared a GoC intervention to usual care, conducted in an academic HF clinic. The GoC intervention was a pre-visit patient activation-education, telephone-based intervention delivered by a nurse. The primary outcome of the study was number of GoC conversations between HF patients and HF providers. Secondary outcomes were quality of communication, number of referrals to palliative care and completion of advance directives. Results Patients averaged 58.15±11.26 years of age, with mean LVEF= 30.31±9.72%, and SHFM scores= 95.1±1.60. There was a significant increase in goals-of-care conversations (58% vs. 2.6%, P<0.001) and quality of end-of-life communication (P=0.03) in the GoC group compared to usual care after the intervention. There were no differences between groups on the other outcomes. Conclusion The GoC intervention resulted in more GoC conversations and higher quality communication between HF patients and providers without increased anxiety or depression. Further studies are needed to assess impact on longer-term quality of care and patient outcomes.

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Does the Type and Frequency of Palliative Care Services Received by Patients with Advanced Heart Failure Impact Symptom Burden?

Cited by 27 publications

References 15 publications

Which patients with heart failure should receive specialist palliative care?

Which patients with heart failure should receive specialist palliative care?

Symptom burden in heart failure: assessment, impact on outcomes, and management

An Intervention to Enhance Goals-of-Care Communication Between Heart Failure Patients and Heart Failure Providers

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