Factors Associated with Perceived Need For Palliative Care Among Patients with Heart Failure

Abstract

Background : Symptom burden, psychological morbidity and advance care planning needs remain high and often unmet among patients with heart failure (HF). Despite recommendations for the utilization of palliative care to address these burdens, palliative care remains greatly underutilized. Insufficient data exists regarding these patients’ preferences and the perceived need for palliative care in patients with HF. Methods : As part of the Hopeful Heart trial, which tested a collaborative care approach for depression and HF, we surveyed participants regarding their perceived need for palliative care. Specifically, they ranked their agreement with the following statement on a 6-item Likert scale: “Palliative/supportive care services would be helpful to me or my family now.” Study inclusion criteria included: systolic HF (ejection fraction ≤45%), NYHA class II-IV symptoms, and a recent HF-related hospitalization at one of 8 Pittsburgh-area hospitals. We compared sociodemographic factors, clinical characteristics and patient-centered outcomes between those with low versus high dichotomized perceived need for palliative care. We also performed logistic regression modeling perceived need as a dichotomized outcome. Results : of 671 patients who completed the outcome assessment, 56% were male with a mean age of 64 years, 73% white, and 62% NYHA Class III-IV. Participants had fair mental (SF-12 MCS, mean: 46.4) and HF-related (KCCQ, mean: 56.6) health related quality of life (HRQoL), and poor physical HRQoL (SF-12 PCS mean: 33.8). Those with high versus low perceived need were more likely to be depressed (87% vs 77%), younger (61 vs 67 years) and non-white (36% vs 31%), and have lower mental (44.7 vs 48.4), physical (32.4 vs 35.4) and HF-related (52.7 vs 61.1) HRQoL (all p≤ 0.004) at baseline. Multivariable models showed depression (odds ratio: 1.86; 95% CI: 1.07-3.23) and non-white race (3.19; 2.07-4.91) were associated with greater dichotomized perceived need, while age ≤ 65 (0.53;0.37-0.76) and lower mental HRQoL (0.98; 0.96-1.00) were associated with lower perceived need for palliative care. Parsimonious models found depression (1.86;1.07-3.23), age ≤ 65 (0.54;0.38-0.75), race (3.26,2.14-4.98) and lower mental (0.98;0.97-1.00) and physical (0.98;0.97-1.00) HRQoL were related to dichotomized need. Conclusions : Among recently hospitalized patients with systolic HF, those who were depressed, younger than 65 years-old, non-white, and reported poorer functional status and HRQoL were most likely to express perceived need for palliative care. These results suggest depression, reduced HRQoL and other factors may better identify patients with HF who would receive benefit from additional symptom support.