Which patients with heart failure should receive specialist palliative care?

Campbell, R. T. et al. (2018) Which patients with heart failure should receive specialist palliative care? European Journal of Heart Failure, 20(9), pp. 1338-1347. (doi: 10.1002/ejhf.1240) (PMID:29952090) (PMCID:PMC6607479)

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Abstract

Aims: We investigated which patients with heart failure (HF) should receive specialist palliative care (SPC) by first creating a definition of need for SPC in patients hospitalised with HF using patient‐reported outcome measures (PROMs) and then testing this definition using the outcome of days alive and out of hospital (DAOH). We also evaluated which baseline variables predicted need for SPC and whether those with this need received SPC. Methods and results: PROMs assessing quality of life (QoL), symptoms, and mood were administered at baseline and every 4 months. SPC need was defined as persistently severe impairment of any PROM without improvement (or severe impairment immediately preceding death). We then tested whether need for SPC, so defined, was reflected in DAOH, a measure which combines length of stay, days of hospital re‐admission, and days lost due to death. Of 272 patients recruited, 74 (27%) met the definition of SPC needs. These patients lived one third fewer DAOH than those without SPC need (and less than a quarter of QoL‐adjusted DAOH). A Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score of <29 identified patients who subsequently had SPC needs (area under receiver operating characteristic curve 0.78). Twenty‐four per cent of patients with SPC needs actually received SPC (n = 18). Conclusions: A quarter of patients hospitalised with HF had a need for SPC and were identified by a low KCCQ score on admission. Those with SPC need spent many fewer DAOH and their DAOH were of significantly worse quality. Very few patients with SPC needs accessed SPC services.

Item Type:Articles
Keywords:Cardiology and cardiovascular medicine.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Hogg, Dr Karen and Mcskimming, Mrs Paula and Jackson, Dr Colette and Jhund, Dr Pardeep and Pozzi, Dr Andrea and McConnachie, Professor Alex and Petrie, Professor Mark and Sonecki, Dr Piotr and Campbell, Dr Ross and McMurray, Professor John and Gardner, Professor Roy and Wright, Mrs Ann
Authors: Campbell, R. T., Petrie, M. C., Jackson, C. E., Jhund, P. S., Wright, A., Gardner, R. S., Sonecki, P., Pozzi, A., McSkimming, P., McConnachie, A., Finlay, F., Davidson, P., Denvir, M. A., Johnson, M. J., Hogg, K. J., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:28 June 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in European Journal of Heart Failure 20(9): 1338-1347
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
615391Palliative Care Needs in Patients with Heart FailureJohn McMurrayBritish Heart Foundation (BHF)PG/13/17/30050RI CARDIOVASCULAR & MEDICAL SCIENCES