Screening and Initiating Supportive Care in Patients With Heart Failure

Abstract

Background: Patients with heart failure (HF) experience a major symptom burden and an overall reduction of quality of life. However, supportive care (SC) remains an under-utilized resource for these patients. Among the many existing barriers to integrating SC into routine care, identifying patients with SC needs remains challenging. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is an important predictor of SC needs in patients with HF.Methods and Results: We used the shortened version KCCQ-12 as a screening tool for SC need in our ambulatory HF patient population using a KCCQ-12 summary score of <29 as the cut-off. Of the 456 patients who completed the KCCQ-12, 41 (9%) were predicted to have SC needs. Demographics, medical history, biochemical parameters, echocardiographic assessment and medical treatment were similar between the two groups of patients. However, patients with KCCQ-12 <29 were more symptomatic based on both New York Heart Association (NYHA) classification and American Heart Association (AHA) staging with a higher prevalence of depression. We established a multidisciplinary SC clinic and the profile and outcomes of patients with SC needs that were referred and followed at our SC clinic were also evaluated. Twenty-three patients were referred to our SC clinic: 2 died before being seen, 1 refused SC and 20 received SC. Of these 20 patients, 11 died and 9 are currently being followed. Median survival after starting the SC clinic is 3 months. In the original SC cohort of 23, 17 patients had available KCCQ-12 summary scores. However, only 6 out of 17 (35%) had KCCQ-12 scores <29, indicating the need for additional assessment tools in this patient population.Conclusions: The magnitude of unmet supportive care needs in patients with HF is significant. While the KCCQ-12 questionnaire is a useful tool to identify patients with SC, serial clinical evaluation, establishment of a SC clinic and prompt referral are essential for patients needing supportive care.

A qualitative meta-synthesis of patients with heart failure perceived needs

“…Supportive care could be developed and provided starting from a CPCC perspective. The concept of CPCC integrates patient and family preferences and needs into the goals of care, manages symptoms to the level of comfort desired, and attempts to reduce the burden of illness on both the patients and their families [48]. In order to undertake this, HPs should extrapolate the unmet needs of each patient with HF via ongoing processes, as the needs change rapidly depending on the trajectory of the illness [9].…”

(Interventions in Care of Patients with Heart Failure for Improvement of Quality of Life)

“…To je příznivý posun, protože pacienti jsou obvykle obklopeni členy rodiny nebo poskytovateli hospicové péče v těchto zařízeních. 22 Poslední studií, jež je součástí tohoto přehledu, je pilotní studie kombinovaného uspořádání zahrnující 33 pacientů se srdečním selháním, která se zaměřovala na zhodnocení proveditelnosti, přijatelnosti a předběžných důkazů o psychospirituální intervenci za účelem zlepšení QoL této populace pacientů. Byla vyvinuta a testována dvanáctitýdenní intervence zaměřená na spiritualitu, stres, coping, zvládání a přizpůsobení se nemoci.…”

A supportive framework for the care of older adults with COPD

“…Pressing issues in COPD care include poor disease understanding, the impact of COPD on function and quality of life, and patient‐centered advance care planning (ACP) 2,3 . Given COPD's incurability and substantial impact on patients, a supportive framework, such as those used to improve quality of life in cancer care and heart failure management, could assist providers in structuring and conducting COPD‐centered visits 4,5 . Our framework approach, described in Figure 1, uses a sequence of questions to engage patients on the topics of disease understanding, symptom burden and impact, and advance care planning.…”

“…2,3 Given COPD's incurability and substantial impact on patients, a supportive framework, such as those used to improve quality of life in cancer care and heart failure management, could assist providers in structuring and conducting COPD-centered visits. 4,5 Our framework approach, described in Figure 1, uses a sequence of questions to engage patients on the topics of disease understanding, symptom burden and impact, and advance care planning. We predict application of this structured approach would demonstrate improvements in patient satisfaction, quality of life, and rates of ACP completion.…”