Palliative Care Interventions for Patients with Heart Failure: A Systematic Review and Meta-Analysis.
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.
['Diop|Michelle S|MS|', 'Rudolph|James L|JL|', 'Zimmerman|Kristin M|KM|', 'Richter|Mary A|MA|', 'Skarf|L Michal|LM|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D003657:Decision Making D005260:Female D006333:Heart Failure D006801:Humans D008297:Male D008875:Middle Aged D010166:Palliative Care D011446:Prospective Studies D011788:Quality of Life D012189:Retrospective Studies
palliative care heart failure symptoms quality of life utilization cultural care