The use of the Seattle Heart Failure Model to Guide Palliative Care Referrals in Advanced Heart Failure

Abstract

Introduction Of the over 6 million individuals living with heart failure (HF) approximately 5% or 300,000 are living with advanced HF. These individuals report a high symptom burden including physical, emotional, and spiritual symptoms; all which contribute to an overall poor quality of life for both the individual and their families. Palliative care principles are recommended to meet the needs of individuals living with HF and their families and should be integrated throughout the illness trajectory, but low utilization of palliative care services in the HF population persists. There are several identified barriers that contribute to lack of palliative care services including the unpredictable illness trajectory, limited acknowledgement of HF terminality, and practitioner uncertainty when to initiate services. Purpose The purpose of this investigation was to determine the utility of the predicted survival score from the Seattle Heart Failure Model (SHFM) as a guide for initiating palliative care referrals. Methods Participants with a SHFM of Results The mean predicted survival for the 100 participants at the time of enrollment from the SHFM was 1.8 years. The 51 participants who died during data collection, had a SHFM predicted survival mean of 1.7 years but a mean actual survival of 0.74 years. Of the 49 participants who were alive at the conclusion of data collection 43% (21/49) outlived their predicted survival. Twelve of the 21 who lived longer than their predicted survival had an intervention (transplant or mechanical circulatory support device). Conclusions Even in the context of those living with advanced HF and a predicted survival of less than 2 years, the HF trajectory remains unpredictable at the end of life which makes the timing of palliative care referrals a challenge. The SHFM does not appear to be an effective screening tool for initiating palliative care services. Palliative care should be viewed as a philosophy of care initiated at the time of diagnosis with components of primary and specialized care.