Table 3.
Summary of Existing Trials of Home-Based Specialty Palliative Care in Heart Failure
| Study (Country) | Patient Population* | Intervention (Participants Randomized) | Control (Participants Randomized) | Results | Risk of Bias | |
|---|---|---|---|---|---|---|
| Subjective | Objective | |||||
| Brännström et al, 2014 (Sweden) | NYHA Class III–IV HF (Mean age: 79) | Predominately in-home HF disease management and palliative care services via a multidisciplinary approach and care coordination (n=36) | Usual care (n=36) |
QOL [EQ5D]: Improved; (57.6 ± 19.2 vs. 48.5 ± 24.4; P=0.05) [KCCQ]: NS (data not reported) Symptom burden [ESAS]: NS (data not reported) Six-month survival: NS; P=0.34 Hospitalizations: reduced; mean (SD)=0.42 (0.60) vs. 1.47 (1.81); P=0.009 Total costs: NS; mean €4078 vs. €5727 (P not reported) Increased proportion of patients with improved NYHA class (39% vs. 9%; P=0.015) |
High | High |
| Wong et al, 2016 (Hong Kong) | Advanced HF (e.g. NYHA stage III–IV) (Mean age: 78) | Palliative care home nurses conducted home visits/telephone calls providing transitional palliative care (n=43) | Usual care (n=41) |
Symptom burden [ESAS]: Proportion of patients with improvement in total score, 73% vs. 41.4%, P<0.05 QOL [McGill]: Improved at 4 weeks; 7.57 points vs. 6.46 points; P<0.001 [Chronic HF Questionnaire]: Improved at 4 weeks; 5.26 points vs. 4.47 points; P<0.001 Satisfaction with care: Higher at 4 weeks; 48.84 points vs. 3.55 points, P<0.001 Hospital readmission: NS at 4 weeks; 20.9% vs. 29.3%, P=0.38; Reduced at 12 weeks: 33.6% vs. 61%, P=0.009 |
High | High |
ACP=Advance Care Planning. ESAS= Edmonton Symptom Assessment Scale. EQ5D= EuroQol Five Dimensions Questionnaire. HF=Heart Failure. KCCQ= Kansas City Cardiomyopathy Questionnaire. NS=Not significant. NYHA=New York Heart Association. QOL=Quality of Life. SD=Standard deviation. USA=United States of America.
*
Patient population details the indication for palliative care. All comparisons stated as intervention vs. control.