Palliative Care Interventions for Patients with Heart Failure: Narrative article

Objective:Palliative care is an interdisciplinary service and an overall approach to care that improves quality of life and alleviates suffering for those living with serious illness, regardless of prognosis. In this review, we synthesize the evidence from randomized clinical trials of palliative care interventions in HF.Background:As HF progresses to the end stage, management of physical, emotional, and spiritual symptoms and advance care planning become the focus of care. Palliative care has also been shown to decrease costs,minimize hospitalizations,and improve patient satisfaction in a variety of populations costs. The purpose of this article is to summarize the available evidence for palliative care interventions in the HF population and to identify the specific practices that are the most effective inimproving patient-centered outcomes.Methods:A systematic search of the PubMed ،Scopus and Cochrane Central Register of Controlled Trials were searched using MeSH database for peer reviewed English language articles published from 2000 to February 2, 2018 was conducted by searching for papers that included both an HF term and a palliative care term. 62 Articles was found and by eligibility criteria 14 articles was included.Results:Interventions varied with respect to team composition and services offered. The studies with improvement in the largest number of outcomes prioritized the integration of interdisciplinary HF and PC(palliative care).Interventions include: Primary Palliative Care(Control pain and other symptoms, Assist with medical decision-making and advance care planning, Assess and reduce emotional distress and burden to patient and family, Coordination of care across patient’s care team, Promote improved quality of life for patient and caregiver).Patient-centered outcomes: Patient quality of life significantly improved in 83% (5/6) of studies, and satisfaction significantly improved in 67% (2/3) of studies.Palliative care interventions were associated with a statistically significant decrease in medical service use in 70% (7/10) of studies. Results were the most robust for decreases in emergency department visits[10],length of stay, overall admissions, intensive care unit admissions, urgent care and primary care visits. In this analysis of rehospitalization in three studies, home based palliative care consults in HF patients lowered the risk of rehospitalization by 42%.The decrease in medical service use was likely of benefit to the patient and was associated with a significant decrease in overall cost of care, as demonstrated in 83% (5/6) of studies.Discussion:The finding of reduced rehospitalization among home-based palliative interventions for HF patients suggests an opportunityfor reducing transitions in an integrated health system.The review found significant improvement in multiple systemprocess measures and health outcomes supporting theintegration of palliative care service and HF disease management.This article also supports the call for further investigationof such integrative interventions to betterunderstand the key factors that contribute to successful care.as evidenced by our finding that40% of studies lacked information about the patient’s partnerstatus. Recent research, however, suggests that includingfamily caregivers in the disease management of patients withHF may improve outcomes.The available studies suggest that interventions consistingof home and team-based palliative care consults combinedwith HF management improve patient outcomes while decreasingcost and utilization.

کلیدواژه ها:

heart failure ، palliative care ، quality of life ، symptoms ، utilization ، Supportive cardiology .Models of care.Family caregiving