Could Palliative Care Benefit Hospitalized Heart Failure Patients?

A new study finds that palliative care may help address the symptoms of patients hospitalized with heart failure (HF).

In an effort to evaluate the spectrum of symptoms experienced by patients hospitalized for HF, the improvement in symptoms after discharge, and patients’ perception of palliative care, a team of researchers studied patients who were hospitalized for heart failure at Yale-New Haven Hospital.
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In total, 91 patients were enrolled, completing a symptom assessment roughly 2 days after being admitted, and again at 1 week after discharge. According to the authors, patients frequently reported severe symptoms typically linked to heart failure, such as fatigue and dyspnea, although less typical symptoms such as anxiety, depression, and pain were also common.

The investigators found that patients often saw no improvement in symptoms after discharge, with nearly 60% demonstrating no improvement in terms of fatigue. More than 40% showed no improvement with regard to their anxiety, dyspnea, or pain. While the majority of patients were initially not familiar with palliative care, two-thirds were interested in receiving it once the concept was explained to them, according to the authors, who note that, while current management approaches may not sufficiently address the symptoms of HF, its “progressive nature … coupled with high mortality rates and poor quality of life, make it suited for the incorporation of palliative care.”

Heart failure is a “chronic progressive illness with a high symptom burden,” says study co-author Rabeea Khan, MD, from the Yale University School of Medicine, department of medicine.

This study “demonstrates that, even after hospital discharge, patients remain symptomatic despite maximal treatment for their cardiac disease,” says Khan. “Primary care practitioners are key clinicians who can work to assure that patients’ symptoms, such as pain, anxiety, depression, and fatigue, are identified and optimally treated.

Primary care physicians may also want to consider referral of patients with advanced heart failure to outpatient palliative care in the community setting, adds Khan.

“Integrating palliative care into outpatient visits can lead to improved symptom control, patients having a greater understanding of their illness, and the assurance that patients make informed decisions about their medical care.”

—Mark McGraw

Reference

Khan R, Feder S, et al. Symptom Burden Among Patients Who Were Hospitalized for Heart Failure. JAMA Intern Med. 2015.