AHA Quality: More Attention to Palliative Care Suggested for Heart Failure Patients

By Charles Bankhead
BALTIMORE, 05 may 2008-- Patients with heart failure have symptom and psychoemotional burdens similar to those of cancer patients, according to a study reported here.
The number of symptoms and scores on assessments of depression and spiritual well-being were no different in 60 outpatients with heart failure than they were in 30 outpatients with advanced lung or pancreatic cancer, David Bekelman, M.D., of the University of Colorado at Denver, said.
In fact, he told attendees at the American Heart Association's Conference on Quality of Care and Outcomes in Cardiovascular Disease and Stroke, heart failure patients with poor health status had more symptoms, were more depressed, and had a lower sense of spiritual well-being than did the cancer patients.
The findings have implications about palliative care for heart failure patients, Dr. Bekelman said.
"Advanced cancer patients are often quite sick and need care focused on quality of life in addition to care focused on the disease," he said. "We don't usually think about providing similar care to outpatients with heart failure."
"Patients with heart failure who are not at the end of life have palliative care needs, but palliative care has been markedly underused in heart failure patients," he added.
The study examined the validity of the assumption that the physical and emotional burdens imposed by heart failure are less severe than those associated with advanced cancer. Most patients with advanced cancer receive palliative care, whereas most patients with heart failure do not.
Dr. Bekelman and colleagues compared patients with heart failure or advanced cancer with respect to three palliative care domains: symptom burden, psychosocial comorbidity, and spiritual well-being. The objective was to assess the relative need for palliative care in the two types of patients.
The heart failure patients were grouped according to ejection fraction and heart failure-specific health status, as assessed by the Kansas City Cardiomyopathy Questionnaire. A score of 50 or lower on the 100-point scale reflected poor health status. All of the cancer patients had nonresectable or metastatic lung or pancreatic cancer.
Both groups of patients completed validated surveys for assessing symptoms, depression, and spiritual well-being. Tabulation of the responses showed no difference between the heart failure and cancer patients with respect to:
Average number of symptoms, 9.1 versus 8.6
Depression score, 3.9 versus 3.2
Spiritual well-being score, 35.9 versus 39.0
Analysis of the data by health status showed that heart failure patients with poor health status had a significantly higher symptom burden (13.2 versus 8.6, P=0.03), depression score (6.7 versus 3.2, P=0.001), and lower spiritual well-being score (29 versus 38.9, P=0.004).
The results suggest that palliative care should be a treatment option for heart failure patients, particularly those with poor health status, the researchers said.
"Clinicians should not underestimate the importance of using supportive communication and empathy with heart failure patients to reduce both symptoms and depression," said Dr. Bekelman.
Dr. Bekelman and co-authors reported no disclosures.
Primary source: AHA Quality ConferenceSource reference:Bekelman D, et al "Symptoms, depression, and spiritual well-being: a comparison of heart failure and advanced cancer patients" AHA Quality Conference 2008; Abstract 171.