Advertisement

Herz

, Volume 44, Issue 5, pp 440–444 | Cite as

Palliative care in heart failure

A meta-analysis of randomized controlled trials
  • K. Zhou
  • Y. MaoEmail author
Review articles

Abstract

Background

Palliative care can play an important role in the management of heart failure. We conducted a systematic review and meta-analysis to compare the efficacy and safety of palliative care in patients with heart failure.

Methods

PubMed, Embase, Web of Science, EBSCO, and the Cochrane Library databases were systematically searched. Randomized controlled trials (RCTs) on the impact of palliative care on heart failure were included. Two investigators independently searched the articles, extracted data, and assessed the quality of included studies. The primary outcome was mortality.

Results

Seven RCTs were included in the meta-analysis. Compared with usual care for heart failure, palliative care was associated with a significantly increased quality of life (standardized mean difference = 1.46; 95% confidence interval [CI] = 0.12 to 2.79; p = 0.03) and reduced depression scores (standardized mean difference = −0.62; 95% CI = −0.99 to −0.25; p = 0.03), but demonstrated no impact on mortality (risk ratio [RR] = 1.28; 95% CI = 0.86 to 1.92; p = 0.22) and rehospitalization (RR = 0.84; 95% CI = 0.66 to 1.07; p = 0.16).

Conclusion

Palliative care can improve the quality of life and reduce the occurrence of depression in patients with heart failure.

Keywords

Palliative therapy Myocardial failure Mortality Randomized controlled trial Meta-analysis 

Palliativversorgung bei Herzinsuffizienz

Metaanalyse randomisierter kontrollierter Studien

Zusammenfassung

Hintergrund

Die Palliativversorgung kann eine wichtige Rolle in der Behandlung der Herzinsuffizienz spielen. Die Autoren führten eine systematische Suche und eine Metaanalyse durch, um die Wirksamkeit und Sicherheit der Palliativversorgung bei Patienten mit Herzinsuffizienz zu vergleichen.

Methoden

Die Datenbanken PubMed, Embase, Web of Science, EBSCO und die Cochrane Library wurden systematisch durchsucht. In die Auswertung aufgenommen wurden randomisierte kontrollierte Studien (RCT) zum Einfluss der Palliativversorgung auf die Herzinsuffizienz. Unabhängig voneinander suchten 2 Untersucher die Artikel heraus, extrahierten Daten und beurteilten die Qualität der in die Auswertung eingeschlossenen Studien. Primärer Endpunkt war die Mortalität.

Ergebnisse

In die Metaanalyse wurden 7 RCT eingeschlossen. Im Vergleich zur gewöhnlichen Behandlung bei Herzinsuffizienz ging die Palliativversorgung mit einer signifikant erhöhten Lebensqualität einher (standardisierte Mittelwertsdifferenz = 1,46; 95%-Konfidenzintervall (KI) = 0,12–2,79; p = 0,03) sowie mit geringeren Depressionsscores (standardisierte Mittelwertsdifferenz = −0,62; 95%-KI = −0,99–−0,25; p = 0,03), zeigte jedoch keine Auswirkung auf die Mortalität (Risk Ratio [RR] = 1,28; 95%-KI = 0,86–1,92; p = 0,22) und eine erneute stationäre Aufnahme (RR = 0,84; 95%-KI = 0,66–1,07; p = 0,16).

Schlussfolgerung

Palliativversorgung kann die Lebensqualität verbessern und das Auftreten von Depressionen bei Patienten mit Herzinsuffizienz verringern.

Schlüsselwörter

Palliativtherapie Myokardinsuffizienz Mortalität Randomisierte kontrollierte Studie Metaanalyse 

Notes

Compliance with ethical guidelines

Conflict of interest

K. Zhou and Y. Mao declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Yancy CW, Jessup M, Bozkurt B et al (2016) 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Failure Society of America. J Am Coll Cardiol 68:1476–1488CrossRefGoogle Scholar
  2. 2.
    Packer M, Pitt B, Rouleau JL et al (2017) Long-term effects of flosequinan on the morbidity and mortality of patients with severe chronic heart failure: primary results of the PROFILE trial after 24 years. JACC Heart Fail 5:399–407CrossRefGoogle Scholar
  3. 3.
    Joyce E, Lala A, Stevens SR et al (2016) Prevalence, profile, and prognosis of severe obesity in contemporary hospitalized heart failure trial populations. JACC Heart Fail 4:923–931CrossRefGoogle Scholar
  4. 4.
    Go AS, Mozaffarian D, Roger VL et al (2013) Executive summary: heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation 127:143–152CrossRefGoogle Scholar
  5. 5.
    Shah SJ, Kitzman DW, Borlaug BA et al (2016) Phenotype-specific treatment of heart failure with preserved ejection fraction: a multiorgan roadmap. Circulation 134:73–90CrossRefGoogle Scholar
  6. 6.
    Jaarsma T, Johansson P, Agren S, Stromberg A (2010) Quality of life and symptoms of depression in advanced heart failure patients and their partners. Curr Opin Support Palliat Care 4:233–237CrossRefGoogle Scholar
  7. 7.
    Bekelman DB, Havranek EP, Becker DM et al (2007) Symptoms, depression, and quality of life in patients with heart failure. J Card Fail 13:643–648CrossRefGoogle Scholar
  8. 8.
    Huang WL, Yang Y, Yang J et al (2017) Use of tolvaptan vs. furosemide in older patients with heart failure : meta-analysis of randomized controlled trials. Herz.  https://doi.org/10.1007/s00059-017-4563-4 Google Scholar
  9. 9.
    Arnold B (2010) ACP Journal Club. Early palliative care improved quality of life in patients with newly diagnosed metastatic NSCLC. Ann Intern Med 153:JC6–JC3Google Scholar
  10. 10.
    Temel JS, Greer JA, Muzikansky A et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742CrossRefGoogle Scholar
  11. 11.
    Wilson KG, Dalgleish TL, Chochinov HM et al (2016) Mental disorders and the desire for death in patients receiving palliative care for cancer. BMJ Support Palliat Care 6:170–177CrossRefGoogle Scholar
  12. 12.
    Goodlin SJ (2009) Palliative care in congestive heart failure. J Am Coll Cardiol 54:386–396CrossRefGoogle Scholar
  13. 13.
    Morrison RS, Dietrich J, Ladwig S et al (2011) Palliative care consultation teams cut hospital costs for medicaid beneficiaries. Health Aff 30:454–463CrossRefGoogle Scholar
  14. 14.
    Kelley AS, Meier DE (2010) Palliative care—a shifting paradigm. N Engl J Med 363:781–782CrossRefGoogle Scholar
  15. 15.
    DeSanto-Madeya S, McDermott D, Zerillo JA et al (2017) Developing a model for embedded palliative care in a cancer clinic. BMJ Support Palliat Care 7:247–250Google Scholar
  16. 16.
    Enguidanos S, Portanova J (2014) The provision of home-based palliative care for those with advanced heart failure. Curr Opin Support Palliat Care 8(1):4–8CrossRefGoogle Scholar
  17. 17.
    Brumley RD, Enguidanos S, Cherin DA (2003) Effectiveness of a home-based palliative care program for end-of-life. J Palliat Med 6:715–724CrossRefGoogle Scholar
  18. 18.
    Bakitas M, Lyons KD, Hegel MT et al (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA 302:741–749CrossRefGoogle Scholar
  19. 19.
    Nieder C, Norum J (2012) Early palliative care in patients with metastatic non-small cell lung cancer. Ann Palliat Med 1:84–86Google Scholar
  20. 20.
    Greer JA, Pirl WF, Jackson VA et al (2012) Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. J Clin Oncol 30:394–400CrossRefGoogle Scholar
  21. 21.
    Sidebottom AC, Jorgenson A, Richards H et al (2015) Inpatient palliative care for patients with acute heart failure: outcomes from a randomized trial. J Palliat Med 18:134–142CrossRefGoogle Scholar
  22. 22.
    Evangelista LS, Lombardo D, Malik S et al (2012) 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 18:894–899CrossRefGoogle Scholar
  23. 23.
    Rogers JG, Patel CB, Mentz RJ et al (2017) Palliative care in heart failure: the PAL-HF randomized, controlled clinical trial. J Am Coll Cardiol 70:331–341CrossRefGoogle Scholar
  24. 24.
    Brannstrom M, Boman K (2014) Effects of person-centred and integrated chronic heart failure and palliative home care. PREFER: a randomized controlled study. Eur J Heart Fail 16:1142–1151CrossRefGoogle Scholar
  25. 25.
    Moher D, Liberati A, Tetzlaff J, Altman DG et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRefGoogle Scholar
  26. 26.
    Higgins JPTGS (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration (Available from www.cochrane-handbook.org.)Google Scholar
  27. 27.
    Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12CrossRefGoogle Scholar
  28. 28.
    Kjaergard LL, Villumsen J, Gluud C (2001) Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 135:982–989CrossRefGoogle Scholar
  29. 29.
    Wong FK, Ng AY, Lee PH et al (2016) Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial. Heart 102:1100–1108CrossRefGoogle Scholar
  30. 30.
    Hopp FP, Zalenski RJ, Waselewsky D et al (2016) Results of a hospital-based palliative care intervention for patients with an acute exacerbation of chronic heart failure. J Card Fail 22:1033–1036CrossRefGoogle Scholar
  31. 31.
    Sahlen KG, Boman K, Brannstrom M (2016) A cost-effectiveness study of person-centered integrated heart failure and palliative home care: based on a randomized controlled trial. Palliat Med 30:296–302CrossRefGoogle Scholar
  32. 32.
    Nwosu AC, Collins B, Mason S (2017) Big data analysis to improve care for people living with serious illness: the potential to use new emerging technology in palliative care. Palliat Med 32(1):164.  https://doi.org/10.1177/0269216317726250 CrossRefGoogle Scholar
  33. 33.
    Horton JR, Morrison RS, Capezuti E et al (2016) Impact of inpatient palliative care on treatment intensity for patients with serious illness. J Palliat Med 19:936–942CrossRefGoogle Scholar
  34. 34.
    Bekelman DB, Rabin BA, Nowels CT et al (2016) Barriers and facilitators to scaling up outpatient palliative care. J Palliat Med 19:456–459CrossRefGoogle Scholar
  35. 35.
    Kelkar AA, Spertus J, Pang P et al (2016) Utility of patient-reported outcome instruments in heart failure. JACC Heart Fail 4:165–175CrossRefGoogle Scholar
  36. 36.
    Allen LA, Stevenson LW, Grady KL et al (2012) Decision making in advanced heart failure: a scientific statement from the American Heart Association. Circulation 125:1928–1952CrossRefGoogle Scholar
  37. 37.
    Lum HD, Carey EP, Fairclough D et al (2016) Burdensome physical and depressive symptoms predict heart failure-specific health status over one year. J Pain Symptom Manage 51:963–970CrossRefGoogle Scholar
  38. 38.
    Stuart B (2007) The nature of heart failure as a challenge to the integration of palliative care services. Curr Opin Support Palliat Care 1(4):249.  https://doi.org/10.1097/SPC.0b013e3282f283b6 CrossRefGoogle Scholar
  39. 39.
    Kavalieratos D, Mitchell EM, Carey TS et al (2014) “Not the ‘grim reaper service’”: an assessment of provider knowledge, attitudes, and perceptions regarding palliative care referral barriers in heart failure. J Am Heart Assoc.  https://doi.org/10.1161/JAHA.113.000544 Google Scholar
  40. 40.
    Gadoud A, Jenkins SM, Hogg KJ (2013) Palliative care for people with heart failure: summary of current evidence and future direction. Palliat Med 27:822–828CrossRefGoogle Scholar
  41. 41.
    Wong FKY, So C, Ng AYM et al (2017) Cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure. Palliat Med.  https://doi.org/10.1177/0269216317706450 Google Scholar
  42. 42.
    Lukas L, Foltz C, Paxton H (2013) Hospital outcomes for a home-based palliative medicine consulting service. J Palliat Med 16:179–184CrossRefGoogle Scholar
  43. 43.
    Wong FK, Chau J, So C et al (2012) Cost-effectiveness of a health-social partnership transitional program for post-discharge medical patients. BMC Health Serv Res 12:479CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department Rehabilitation MedicineNingbo No. 2 HospitalNingboChina
  2. 2.Emergency DepartmentNinghai First HospitalNinghaiChina

Personalised recommendations