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)
Summary
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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