Spiritual Support in Advanced Heart Failure

Abstract

Heart failure is a complex, progressive disease with an uncertain trajectory. Those with advanced heart failure (AHF) experience substantial spiritual needs. Spiritual interventions may enhance quality of life and reduce anxiety and depression, but studies are limited and none have focused exclusively on the AHF patient population. This is the first feasibility randomized controlled trial (RCT) to ascertain the clinical and cost effectiveness of a spiritual intervention (spiritual support) in AHF patients. A total of 47 AHF patients were randomized to control (standard care, n = 25) or intervention (standard care plus spiritual support, n = 22) groups. Spiritual support consisted of a one-hour discussion facilitated by trained volunteers using a “Spiritual Enquiry Tool” at two-monthly intervals over six months. Participants completed validated measures of spiritual well-being, depression/anxiety, and health-related quality of life (QoL). Purpose-designed questionnaires gathered information on demographics, NHS resource use, confounding factors, and satisfaction with spiritual support. The new information was to help researchers design an RCT to determine the clinical and cost effectiveness of spiritual support within a holistic model of care for AHF patients. Future trends worthy of further investigation include (i) the possible positive effect of spiritual support on QoL and anxiety, and (ii) possible lower NHS resource use and cost savings in patients receiving spiritual support. Overall, the key message of this study is that researchers must evaluate whether the cost of running a well-designed trial of this nature is justified in the current economic climate, where funding bodies are looking for value for money.