From kellierae [Image], 2015, https://pixabay.com/illustrations/elderly-caregiver-support-9514821/. Pixabay CC BY 2.0
Background: Chronic heart failure (HF) is a life limiting illness that can greatly affect a persons’ quality of life by limiting mobility, causing pain and dyspnea, frequent hospitalizations, and psychological distress. As the disease progresses, their needs increase and change. Palliative care’s multidisciplinary approach can bring much needed support to those with end-stage HF, but the timing of palliative care engagement in chronic HF is unknown. The goal of this study is to evaluate the benefits of palliative care in chronic HF and identify the optimal time for engagement.
Design and Participants: This was a case-control study from January 2018-December 2020. One hundred and eighty participants were >60 years old, were diagnosed with chronic HF with a New York Heart Association (NYHA) grade 1-3, were cognitively intact and had no other life limiting illnesses such as neurological disease, obesity, or cancer. Participants were classified based on their NYHA grade and then randomized 1:1. Demographics, QOL assessments such as self-care and sleep quality, and cardiac function were assessed. The control cohort underwent usual care which included symptom management, exercise, and diet. The intervention group underwent usual care plus palliative care intervention for 24 weeks. The palliative care intervention involved a psychological analysis by a nurse who coordinated the treatment plan with the cardiology provider who managed blood pressure control, water and salt intake, exercise and sleep; the psychological counselor who provided education and relaxation therapy; and caregivers. Assessments were then repeated. Analysis was performed.
Results: All 180 participants completed the study. They were on average 71.5 yo and had chronic HF for 66.9 months. Their LVEF was 39.3%. Both groups performed similarly on the assessments prior to intervention. At the 6 month follow up, those in the study group who had palliative care intervention scored significantly higher on the self-care maintenance, management, confidence and quality of life scale. The difference was most profound in the NYHA grade 2 and 3 groups. There was no statistical difference in the NYHA grade 1 group. Interestingly, prior to intervention, both groups were the same with regard to LVEF and BNP levels. Again, NYHA grades 2 and 3 demonstrated a significantly improved LVEF and decreased BNP after the palliative care intervention with no difference in the NYHA grade 1 cohort.
Commentary: Chronic HF is a debilitating, life limiting illness that leads to frequent hospitalizations and death. This article demonstrates a specific palliative care intervention. Their findings illustrate the need for palliative care in this population. The participants, 6 months after the intervention, continued to participate in their self-care through health promoting practices and illness management like medication compliance, exercise, diet, tracking weights and symptoms, and fluid management. Furthermore, their analysis demonstrates that engagement with NYHA grades 2 and 3 significantly improves these patients’ quality of life, arguing for palliative care engagement at these earlier grades.
Bottom Line: Chronic HF significantly impacts a patient’s quality of life and their engagement in their health. Early palliative care interventions in patients with NYHA grades 2 and 3 significantly improve their quality of life and self-care, resulting in improved heart function.
Source: Pan L, Qiao L, Zhang Y, et al. Effectiveness of timely implementation of palliative care on the well-being of patients with chronic heart failure. J Palliat Care. 2024;39(4):282-288. doi: 10.1177/08258597231184798 journals.sagepub.com/home/pal
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