medwireNews: The early integration of palliative care (EIPC) with standard cardiac care did not enhance the health status and mood of patients with nonterminal heart failure (HF) in the EPCHF study, but it did boost their spiritual wellbeing.
This improvement in spiritual wellbeing was seen exclusively among patients receiving EIPC who had lower levels at baseline, which underscores “its unique potential benefits,” say the investigators, although the difference at 12 months was not significant compared with those receiving standard cardiac care only.
Mahmoud Balata (University Hospital Bonn, Germany) and colleagues suggest that the lack of a significant benefit on health status “could be attributed to the characteristics of our patient cohort,” who in contrast to HF patients in other similar studies “were not in the terminal stages of their illness.”
In all, 100 HF patients were randomly assigned to receive EIPC alongside standard cardiac care and 105 to receive standard cardiac care alone between May 2019 and November 2021. The participants had New York Heart Association HF of class II or above (40% class II and 47% class III) and N-terminal pro B-type natriuretic peptide levels of at least 400 pg/mL (median 2216 pg/mL). They had a median age of 67 years and 70% were men.
The participants assigned to standard cardiac care received guideline-directed care plus outpatient follow-ups every 3 months for a year. They could also request additional support from dedicated HF nurses if they needed further help or reassurance regarding medication. The patients in the EIPC group received the same cardiac care plus monthly 30–60-minute EIPC consultations, involving care from board-certified physicians and qualified social workers from the German Association of Palliative Medicine.
During the 12-month follow-up period, scores on the Functional Assessment of Chronic Illness Therapy Palliative Care (FACIT-PAL), a measure of wellbeing, significantly improved in both groups, increasing by a mean of 4.9 points in the EIPC group and 3.8 points in the standard cardiac care group, from a baseline mean of 39.0 and 40.0 points, respectively.
Likewise, scores on the Kansas City Cardiomyopathy Questionnaire (KCCQ), which measures health status, improved significantly in both treatment arms to a similar extent. The mean score in the EIPC group rose by 22.6 points compared with 22.5 points with standard cardiac care, from a respective 52.0 and 41.0 points at baseline.
Comparable significant improvements were seen with both interventions for secondary endpoints, including levels of anxiety and depression on the Hospital Anxiety and Depression scale, and physical and emotional distress on a German adaptation of the Edmonton Symptom Assessment Scale.
The researchers note that only patients receiving EIPC had a significant improvement in spiritual wellbeing scores on the FACIT-SP12 scale, increasing from a mean of 29.0 points at baseline to approximately 32.5 points at 12 months. However, this did not differ significantly from the score for the cardiac care only group, whose mean baseline score was already 31.0 points.
Balata et al write in The Lancet Healthy Longevity that the results “support integrating palliative care with standard management of patients with heart failure to enhance overall patient care.”
They continue: “This integration shows potential to enhance spiritual wellbeing, as evidenced in our study, and to reduce pain and daily living interference, as shown in the ENABLE CHF-PC study.”
The authors add that “despite the study’s relatively long duration of 1 year, there is a possibility that this timeframe might not have been adequate to fully capture meaningful changes in patients’ health status and mood.”
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