Efficacy of palliative care in heart failure patients: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Jiayin ¹ , ZONG Wenjie ² ,  ZOU Haiou ³

1. Institute of Medical Information, CAMS and PUMC, Beijing 100020, P. R. China;
2. Peking Union Medical College Hospital, Beijing 100005, P. R. China;
3. School of Nursing, Peking Union Medical College, Beijing 100144, P. R. China;

Corresponding author：

ZOU Haiou, Email: haiou5275@163.com

Keywords：

Palliative care; Heart failure; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.202110036

Video：

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Objective To systematically review the efficacy of palliative care in heart failure patients. Methods PubMed, EMbase, CINAHL, The Cochrane Library, VIP, CNKI, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of palliative care in heart failure patients from inception to September 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCTs involving 912 patients were included. The results of meta-analysis showed that palliative care could improve the quality of life of patients with heart failure (KCCQ & McGill QoL: SMD=0.85, 95%CI 0.13 to 1.58, P=0.02; MLHFQ: SMD=−1.32, 95%CI −2.10 to −0.54, P=0.000 9), reduce the level of depression (SMD=−0.58, 95%CI −0.87 to −0.28, P=0.000 1) and anxiety (SMD=−0.51, 95%CI −0.89 to −0.13, P=0.008), improve the adverse symptoms (SMD=−1.46, 95%CI −2.67 to −0.24, P=0.02), reduce the readmission rate (RR=0.64, 95%CI 0.42 to 0.98, P=0.04) and the per hospitalization time (MD=−0.94, 95%CI −1.28 to −0.60, P<0.000 01). However, it had no obvious effect on the mortality of patients (RR=1.00, 95%CI 0.63 to 1.57, P=0.99). Conclusion Current evidence shows that palliative care can improve the quality of life, emotional state and adverse symptoms of patients with heart failure, and reduce the length of hospital stay and readmission rate. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.

Citation： ZHOU Jiayin, ZONG Wenjie, ZOU Haiou. Efficacy of palliative care in heart failure patients: a systematic review. Chinese Journal of Evidence-Based Medicine, 2022, 22(2): 148-153. doi: 10.7507/1672-2531.202110036 Copy

1.	Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation, 2013, 128(16): e240-327.
2.	Dharmarajan K, Rich MW. Epidemiology, pathophysiology, and prognosis of heart failure in older adults. Heart Fail Clin, 2017, 13(3): 417-426.
3.	Costanzo MR, Mills RM, Wynne J. Characteristics of "Stage D" heart failure: insights from the acute decompensated heart failure national registry longitudinal module (ADHERE LM). Am Heart J, 2008, 155(2): 339-347.
4.	Unroe KT, Greiner MA, Hernandez AF, et al. Resource use in the last 6 months of life among medicare beneficiaries with heart failure, 2000-2007. Arch Intern Med, 2011, 171(3): 196-203.
5.	Sepúlveda C, Marlin A, Yoshida T, et al. Palliative care: the world health organization's global perspective. J Pain Symptom Manage, 2002, 24(2): 91-96.
6.	Zimmermann C, Swami N, Krzyzanowska M, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet, 2014, 383(9930): 1721-1730.
7.	Whellan DJ, Goodlin SJ, Dickinson MG, et al. End-of-life care in patients with heart failure. J Card Fail, 2014, 20(2): 121-134.
8.	Maciver J, Ross HJ. A palliative approach for heart failure end-of-life care. Curr Opin Cardiol, 2018, 33(2): 202-207.
9.	Teno JM, Clarridge BR, Casey V, et al. Family perspectives on end-of-life care at the last place of care. JAMA, 2004, 291(1): 88-93.
10.	Diop MS, Rudolph JL, Zimmerman KM, et al. Palliative care interventions for patients with heart failure: a systematic review and meta-analysis. J Palliat Med, 2017, 20(1): 84-92.
11.	Zhou K, Mao Y. Palliative care in heart failure: A meta-analysis of randomized controlled trials. Herz, 2019, 44(5): 440-444.
12.	Evangelista LS, Lombardo D, Malik S, et al. Examining the effects of an outpatient palliative care consultation on symptom burden, depression, and quality of life in patients with symptomatic heart failure. J Card Fail, 2012, 18(12): 894-899.
13.	Brännström M, Boman K. Effects of person-centred and integrated chronic heart failure and palliative home care. PREFER:a randomized controlled study. Eur J Heart Fail, 2014, 16(10): 1142-1151.
14.	陈霞. 姑息护理在终末期心衰患者中的应用效果. 天津护理, 2016, 24(3): 201-203.
15.	Hopp FP, Zalenski RJ, Waselewsky D, et al. Results of a hospital-based palliative care intervention for patients with an acute exacerbation of chronic heart failure. J Card Fail, 2016, 22(12): 1033-1036.
16.	Ng AYM, Wong FKY. Effects of a home-based palliative heart failure program on quality of life, symptom burden, satisfaction and caregiver burden: a randomized controlled trial. J Pain Symptom Manage, 2018, 55(1): 1-11.
17.	Rogers JG, Patel CB, Mentz RJ, et al. Palliative care in heart failure: The PAL-HF randomized, controlled clinical trial. J Am Coll Cardiol, 2017, 70(3): 331-341.
18.	Wong FKY, So C, Ng AYM, et al. Cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure. Palliat Med, 2018, 32(2): 476-484.
19.	李学平, 缑红艳, 林国新. 姑息护理在终末期心衰患者中的应用效果研究. 世界最新医学信息文摘, 2017, 17(19): 227.
20.	O'Donnell AE, Schaefer KG, Stevenson LW, et al. Social worker-aided palliative care intervention in high-risk patients with heart failure (SWAP-HF): a pilot randomized clinical trial. JAMA Cardiol, 2018, 3(6): 516-519.
21.	曹佳, 曹文红, 李月琴. 姑息护理模式对终末期心力衰竭患者再入院率和生活质量的影响. 心脑血管病防治, 2019, 19(1): 102-105.
22.	史秀霞, 田丽, 吕丹. 心力衰竭患者及照顾者接受姑息治疗的效果评价. 广东医学, 2019, 40(7): 967-971.
23.	Kavalieratos D, Gelfman LP, Tycon LE, et al. Palliative care in heart failure: rationale, evidence, and future priorities. J Am Coll Cardiol, 2017, 70(15): 1919-1930.
24.	Årestedt K, Alvariza A, Boman K, et al. Symptom relief and palliative care during the last week of life among patients with heart failure: a national register study. J Palliat Med, 2018, 21(3): 361-367.
25.	Thoonsen B, Vissers K, Verhagen S, et al. Training general practitioners in early identification and anticipatory palliative care planning: a randomized controlled trial. BMC Fam Pract, 2015, 16: 126.
26.	Selman L, Harding R, Beynon T, et al. Improving end-of-life care for patients with chronic heart failure: "Let's hope it'll get better, when I know in my heart of hearts it won't". Heart, 2007, 93(8): 963-967.
27.	Mentz RJ, O'Connor CM, Granger BB, et al. Palliative care and hospital readmissions in patients with advanced heart failure: Insights from the PAL-HF trial. Am Heart J, 2018, 204: 202-204.
28.	Stewart S, MacIntyre K, Hole DJ, et al. More 'malignant' than cancer. Five-year survival following a first admission for heart failure. Eur J Heart Fail, 2001, 3(3): 315-322.
29.	Brännström M, Boman K. A new model for integrated heart failure and palliative advanced homecare-rationale and design of a prospective randomized study. Eur J Cardiovasc Nurs, 2013, 12(3): 269-275.

1. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation, 2013, 128(16): e240-327.
2. Dharmarajan K, Rich MW. Epidemiology, pathophysiology, and prognosis of heart failure in older adults. Heart Fail Clin, 2017, 13(3): 417-426.
3. Costanzo MR, Mills RM, Wynne J. Characteristics of "Stage D" heart failure: insights from the acute decompensated heart failure national registry longitudinal module (ADHERE LM). Am Heart J, 2008, 155(2): 339-347.
4. Unroe KT, Greiner MA, Hernandez AF, et al. Resource use in the last 6 months of life among medicare beneficiaries with heart failure, 2000-2007. Arch Intern Med, 2011, 171(3): 196-203.
5. Sepúlveda C, Marlin A, Yoshida T, et al. Palliative care: the world health organization's global perspective. J Pain Symptom Manage, 2002, 24(2): 91-96.
6. Zimmermann C, Swami N, Krzyzanowska M, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet, 2014, 383(9930): 1721-1730.
7. Whellan DJ, Goodlin SJ, Dickinson MG, et al. End-of-life care in patients with heart failure. J Card Fail, 2014, 20(2): 121-134.
8. Maciver J, Ross HJ. A palliative approach for heart failure end-of-life care. Curr Opin Cardiol, 2018, 33(2): 202-207.
9. Teno JM, Clarridge BR, Casey V, et al. Family perspectives on end-of-life care at the last place of care. JAMA, 2004, 291(1): 88-93.
10. Diop MS, Rudolph JL, Zimmerman KM, et al. Palliative care interventions for patients with heart failure: a systematic review and meta-analysis. J Palliat Med, 2017, 20(1): 84-92.
11. Zhou K, Mao Y. Palliative care in heart failure: A meta-analysis of randomized controlled trials. Herz, 2019, 44(5): 440-444.
12. Evangelista LS, Lombardo D, Malik S, et al. Examining the effects of an outpatient palliative care consultation on symptom burden, depression, and quality of life in patients with symptomatic heart failure. J Card Fail, 2012, 18(12): 894-899.
13. Brännström M, Boman K. Effects of person-centred and integrated chronic heart failure and palliative home care. PREFER:a randomized controlled study. Eur J Heart Fail, 2014, 16(10): 1142-1151.
14. 陈霞. 姑息护理在终末期心衰患者中的应用效果. 天津护理, 2016, 24(3): 201-203.
15. Hopp FP, Zalenski RJ, Waselewsky D, et al. Results of a hospital-based palliative care intervention for patients with an acute exacerbation of chronic heart failure. J Card Fail, 2016, 22(12): 1033-1036.
16. Ng AYM, Wong FKY. Effects of a home-based palliative heart failure program on quality of life, symptom burden, satisfaction and caregiver burden: a randomized controlled trial. J Pain Symptom Manage, 2018, 55(1): 1-11.
17. Rogers JG, Patel CB, Mentz RJ, et al. Palliative care in heart failure: The PAL-HF randomized, controlled clinical trial. J Am Coll Cardiol, 2017, 70(3): 331-341.
18. Wong FKY, So C, Ng AYM, et al. Cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure. Palliat Med, 2018, 32(2): 476-484.
19. 李学平, 缑红艳, 林国新. 姑息护理在终末期心衰患者中的应用效果研究. 世界最新医学信息文摘, 2017, 17(19): 227.
20. O'Donnell AE, Schaefer KG, Stevenson LW, et al. Social worker-aided palliative care intervention in high-risk patients with heart failure (SWAP-HF): a pilot randomized clinical trial. JAMA Cardiol, 2018, 3(6): 516-519.
21. 曹佳, 曹文红, 李月琴. 姑息护理模式对终末期心力衰竭患者再入院率和生活质量的影响. 心脑血管病防治, 2019, 19(1): 102-105.
22. 史秀霞, 田丽, 吕丹. 心力衰竭患者及照顾者接受姑息治疗的效果评价. 广东医学, 2019, 40(7): 967-971.
23. Kavalieratos D, Gelfman LP, Tycon LE, et al. Palliative care in heart failure: rationale, evidence, and future priorities. J Am Coll Cardiol, 2017, 70(15): 1919-1930.
24. Årestedt K, Alvariza A, Boman K, et al. Symptom relief and palliative care during the last week of life among patients with heart failure: a national register study. J Palliat Med, 2018, 21(3): 361-367.
25. Thoonsen B, Vissers K, Verhagen S, et al. Training general practitioners in early identification and anticipatory palliative care planning: a randomized controlled trial. BMC Fam Pract, 2015, 16: 126.
26. Selman L, Harding R, Beynon T, et al. Improving end-of-life care for patients with chronic heart failure: "Let's hope it'll get better, when I know in my heart of hearts it won't". Heart, 2007, 93(8): 963-967.
27. Mentz RJ, O'Connor CM, Granger BB, et al. Palliative care and hospital readmissions in patients with advanced heart failure: Insights from the PAL-HF trial. Am Heart J, 2018, 204: 202-204.
28. Stewart S, MacIntyre K, Hole DJ, et al. More 'malignant' than cancer. Five-year survival following a first admission for heart failure. Eur J Heart Fail, 2001, 3(3): 315-322.
29. Brännström M, Boman K. A new model for integrated heart failure and palliative advanced homecare-rationale and design of a prospective randomized study. Eur J Cardiovasc Nurs, 2013, 12(3): 269-275.

Chinese Journal of Evidence-Based Medicine

Efficacy of palliative care in heart failure patients: a systematic review

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