Abstract

Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design. Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36; 26 males, 10 females, mean age: 81.9 years) or control group (n = 36; 25 males, 11 females, mean age:76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study. Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074); NT-proBNP increased 4% in the control group. Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.

Highlights

  • Patients with chronic heart failure (CHF) have symptoms as severe and distressing as those of patients with cancer, but do not have equal access to palliative care [1]

  • We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group

  • Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36; 26 males, 10 females, mean age: 81.9 years) or control group (n = 36; 25 males, 11 females, mean age: 76.5 years)

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Summary

Introduction

Patients with chronic heart failure (CHF) have symptoms as severe and distressing as those of patients with cancer, but do not have equal access to palliative care [1]. The course of CHF is unpredictable, complicating the choice of a specific point for introducing palliative care into general heart failure management [2]. Patients with CHF often require frequent hospitalizations and readmissions, suggesting insufficient management that may be attributable to the frequency of concomitant chronic diseases [1] [3] [4]. Serial NP measurements may guide drug treatment for patients with CHF [14] [15], but the role of these measurements in palliative care has not been evaluated

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