Palliative care need in patients with advanced heart failure hospitalized in a tertiary hospital

Abstract

Objective: To evaluate the need for palliative care in patients with advanced Congestive Heart Failure (CHF) hospitalized in a cardiology ward. Method: Application of the World Health Organization Palliative Needs tool (NECPAL) with the assistant physician, patient and/or caregiver for evaluation of indication of Palliative Care (PC). Results: 82 patients with a diagnosis of class III/IV Heart Failure or ejection fraction less than or equal to 40% in echocardiography of the last 12 months were included: Mean age 68 ± 20 years, 51 male patients and 31 female patients. Forty-three patients (52.4%) were married or in consensual union and ten (12%) lived alone. The death of 46 patients (56.1%) in the subsequent 12 months would not surprise their physician, and forty-five patients (55%) had palliative care indication according to the NECPAL. Conclusion: About half of patients hospitalized for class III/IV Heart Failure would have an indication of Palliative Care for the relief of suffering caused by the disease.

Palliative care needs-assessment and measurement tools used in patients with heart failure: a systematic mixed-studies review with narrative synthesis

“…RADPAC-trained primary care practitioners identified a few patients for palliative care [62], most likely because the tool covers only physical patient needs so it could not identify those with psychosocial and spiritual needs. For NECPAL, more than 90% of patients with a negative answer to the surprise question were identified by the tool across all the evaluating studies [52][53][54]67], which may suggest a little added value of the detailed NECPAL compared with the surprise question alone.…”

“…Among these, 27 papers were included in the review about 19 studies. The included studies differ in their design: ten were quantitative [19,[44][45][46][47][48][49][50][51][52][53][54], one qualitative [55], and eight of mixedmethods design [26,[56][57][58][59][60][61][62][63][64][65][66][67][68]. All studies were observational except for one interventional study [61][62][63][64], one pilot study [59], and one feasibility study [26,56].…”

“…SPICT identified only a few patients with heart failure although the proportion in one study was misleadingly high because of the small sample size [48]. GSF-PIG identified 86% of patients with heart failure in one study [19], while NECPAL identified 32%, 55%, and 91% in three studies [53,54,67]. IPOS and NAT:PD-HF identified 56% and 26% of patients with heart failure for specialist palliative care, respectively [51,57].…”

“…The tool is robust if the patients it identified for palliative care had evidence of poor health. Poor health at baseline, evidenced by poor scoring in patient outcome measures, long or frequent hospitalizations, old age, and/or New York Heart Association (NYHA) class III-IV, was shown for many patients identified by IPOS [57], GSF-PIG [19,45,46], NAT:PD-HF [51,59], and NECPAL [53,54]. Likewise, better health at baseline, evidenced by NYHA class I-II, was observed in many patients who reported few significant psychological, social, and spiritual concerns in NAT:PD-HF [58].…”

Tools to help healthcare professionals recognize palliative care needs in patients with advanced heart failure: A systematic review

“…Nececidades paliativas (NECPAL) Gomez et al 44 Spain Development Orzechowski et al 45 Brazil Evaluation Gastelurrutia et al 46 Spain Evaluation System (ESAS), Australia-modified karnofsky Performance scale (AkPs), and the Caregiving Questionnaire for Palliative Care (FACQ-PC) as gold standards regarding the NAT: PD-HF level of concern items. Criterion validity was slightly shown for the physical item, but was not confirmed for the psychological, daily living, and caregiver distress items.…”