Using Heart Failure Instruments To Determine When To Refer Heart Failure Patients to Palliative Care

Abstract

Purpose Assessing the need for palliative care in heart failure (HF) is difficult because of the fluctuating disease course. The Palliative Performance Scale (PPS) and the Edmonton Symptom Assessment Score (ESAS) are instruments used by palliative care programs to determine disease severity and the need for palliative care services. These tools were developed and evaluated in a cancer population and there is limited evidence on their applicability to the HF population. The purpose of our study was to determine if scores on the cancer scales (ESAS and PPS) correlated with the scores on heart failure scales (MLHFQ, VAS and SHFM) in order to determine if heart failure scores can be used to trigger a referral to palliative care. Methods and Materials We administered the ESAS, MLHFQ, VAS, PPS and SHFM in a shuffled manner to 78 NYHA FC III-IV ambulatory HF patients followed at a tertiary care HF clinic. We used Pearson’s Correlation to determine if the ESAS and the PPS correlated with the MLHFQ, Overall Health VAS and 1-year SHFM predicted survival. Results The population was predominately male (62.8%), mean age 60.1 ± 13 years and a diagnosis of idiopathic cardiomyopathy (45%). There were moderate correlations between the ESAS and the MLHFQ (r = 0.483, p Conclusions The relapsing/remitting nature of heart failure makes it difficult to estimate when patients are nearing end-of-life. This study shows a significant relationship between palliative care scales and heart failure instruments suggesting that patients with multiple symptoms or individual symptom scores > 7, MLHFQ scores > 60 and/or overall health VAS scores