Table 1.
Summary of Existing Trials of Inpatient Specialty Palliative Care in Heart Failure
| Study (Country) | Patient Population* | Intervention (Participants Randomized) | Control (Participants Randomized) | Results | Risk of Bias | |
|---|---|---|---|---|---|---|
| Subjective | Objective | |||||
| Hopp et al, 2016 (USA) | Acute HF, 1-yr mortality risk of ≥33%, and/or NYHA Class III–IV (Mean age: 68) | Inpatient specialist consultation from a multidisciplinary team (physician, nurse practitioner, chaplain, social worker) conducted clinical interview(s), assessing symptoms, goals of care and post- treatment location desires, and advance care planning (n=43) | Usual care (n=42) | Hospice utilization/ACP (Composite outcome): NS; difference between groups 9.3% (95% CI: −11.8%, 30.0%) | High | High |
| Sidebottom et al, 2014 (USA) | Acute HF (Mean age: 73) | Specialty multidisciplinary palliative care consultation assessing physical and emotional symptoms, spiritual, and social aspects of care. (n=116) | Usual care (n=116) |
QOL [Minnesota Living with Heart Failure Questionnaire]: Improved, mean difference 3.06 points (95% CI: 2.75, 3.37) Symptom burden [ESAS]: Improved total symptom burden, mean difference 4.31 points (95% CI: 4.00, 4.62) Six-month mortality: NS; HR, 1.90 (95% CI: 0.88, 4.09) 30-day hospital readmission: NS; HR, 1.43 (95% CI: 0.5, 4.1) Hospice use within 6 months: NS; HR, 1.60 (95% CI: 0.58, 4.38) ACP within 6 months: Improved; HR, 2.87 (95% CI: 1.09, 7.59) Mood [PHQ-9]: Improved; mean difference, 0.72 (95% CI: 0.41, 1.03) |
High | High |
ACP=Advance Care Planning. CI=Confidence Interval. ESAS= Edmonton Symptom Assessment Scale. HF=Heart Failure. NS=Not significant. NYHA=New York Heart Association. PHQ-9= Patient Health Questionnaire 9. QOL=Quality of Life. USA=United States of America.
*
Patient population details the indication for palliative care. All comparisons stated as intervention vs. control.