Educate, Nurture, Advise, Before Life Ends: Comprehensive Heart Care for Patients and Families (ENABLE CHF-PC): An Early Palliative Care Telehealth Randomized Trial for Patients with Advanced Heart Failure (FR440A)

Abstract

•Describe an early palliative care telehealth model for patients with advanced heart failure.•Synthesize the results and implications of an early palliative care study for patients with heart failure. Palliative care (PC) for advanced stage heart failure (HF) is recommended by national organizations and guidelines, however there are few tested integrated HF PC models. Determine the effect of a nurse coach-led, PC telehealth intervention (ENABLE CHF-PC) on advanced HF patients' quality of life (QOL) and mood over 32 weeks. Intervention (INV) vs. usual HF care (UC) randomized clinical trial (August 2016-October 2018) at a tertiary academic and Veteran's Affairs Medical Center serving high proportions of rural and African American (AA) patients. NYHA Class III/IV HF patients received UC or ENABLE CHF-PC consisting of an in-person PC consultation and 6 weekly nurse-coach psychoeducational telephonic sessions and monthly follow-up for 1 year. Primary outcomes were QoL (Kansas City Cardiomyopathy Questionnaire [KCCQ] & [FACIT-pal-14]) and mood (Hospital Anxiety Depression Scale [HADS]) over 32 weeks. Of 415 patient participants, mean age was 64, 53% male; 55% AA; 26% rural; 46% 0.05) <high-school education; 75% reported having a caregiver; 47% reported reduced QoL (KCCQ clinical summary score ≤ 50). Over 32 weeks, trends favored INV group (mean KCCQ improved 5.1 points (±1.4 SD) INV versus 2.7 (±1.3) UC; mean FACIT-pal-14 improved 1.8 (±0.6) INV vs 0.9 (±0.6) UC; HADS-anxiety decreased equally in both groups (±-0.1) and HADS-depression decreased -0.9 (±0.3) INV vs -0.5 (±0.2) UC); however there was not a clinically significant improvement in INV group QOL and mood compared to UC (all p's>0.05). The lack of a clinically significant improvement in the INV relative to UC group may be explained by relatively high mean baseline QOL and mood scores. The high proportion of AA participants suggests acceptability of early PC in this population.