Does the Type and Dose of Palliative Care Services Impact Symptom Control in Patients with Advanced Heart Failure?

Abstract

Does the Type and Dose of Palliative Care Services Impact Symptom Control in Patients with Advanced Heart Failure? Lorraine S. Evangelista 1 , Jennifer Ballard-Hernandez 2 , Dawn Lombardo 2 , Shaista Malik 2 , Marjan Motie 1 , Solomon Liao 2 ; 1 University of California Irvine, Irvine, CA; 2 University of California Irvine, Irvine, CA Introduction: Outpatient palliative care (PC) for patients with symptomatic heart failure (HF) is a relatively new practice and few data exist that describe the nature of these clinical encounters. Hypothesis: We hypothesized that the nature of outpa- tient PC services (i.e. type, duration, frequency) used by patients with advanced HF would impact symptom burden 3 months post-discharge. Methods: This study was conducted at a single, tertiary care medical center. Patients were recruited from the inpatient setting during an episode of acute HF exacerbation and referred for an ini- tial PC consultation and subsequent follow-up support with the PC team. Data on PC services accessed were monitored over 3 months. Surveys were conducted immedi- ately after and 3 months post-discharge to assess symptom burden. Results: Thirty six patients completed the initial PC consultation with a PC specialist (17%) or ad- vanced practice nurse (83%); care focused on physical and psychosocial assessment (100%), advanced care planning (100%), symptom management (81%), illness un- derstanding (69%), and patient and family coping (50%). Median total time for the initial PC consultation was 75 minutes (range 50-120). Twenty-nine (83.7%) agreed to receive additional PC support (Figure 1); median number of visits per patient was 2 (range 1-4). Marked improvements in all symptoms, except depression, were noted at 3 months (Table 1). Participants who sought PC services beyond the initial consulta- tion reported significantly better symptom control than their counterparts (P!.050). Conclusion: Our findings suggest that the type and dose of PC significantly improved the symptoms evaluated. Randomized controlled trials are indicated to further eval- uate the effectiveness of PC services in patients with advanced HF.