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The impact of palliative care on clinical and patient‐centred outcomes in patients with advanced heart failure: a systematic review of randomized controlled trials
Author(s) -
Sahlollbey Nick,
Lee Christopher Kai Seng,
Shirin Afraah,
Joseph Philip
Publication year - 2020
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1783
Subject(s) - medicine , palliative care , randomized controlled trial , cinahl , medline , heart failure , quality of life (healthcare) , odds ratio , confidence interval , psychological intervention , adverse effect , intensive care medicine , meta analysis , emergency medicine , physical therapy , nursing , political science , law
Aims To examine the impact of palliative care on acute care hospitalizations, survival, symptoms, and quality of life (QOL) in patients with advanced heart failure. Methods and results We conducted a systematic search of publications through CENTRAL, CINAHL, EMBASE, and MEDLINE originally up to July 2017, and then updated to June 2019. The study was registered (PROSPERO ID: CRD42017069685) prior to its initiation. Randomized controlled trials (RCTs) were included that tested an interdisciplinary palliative care intervention (compared to usual care) primarily in a heart failure population. Main outcomes assessed were hospitalizations, mortality, QOL, and symptom burden. Ten independent RCTs were selected, representing a total of 1050 participants (921 with a diagnosis of heart failure). Compared with usual care, palliative care interventions were associated with a substantial reduction in hospitalizations [odds ratio 0.56 (0.33–0.94); four trials; I 2 = 27%], modest improvement in QOL [standardized mean difference (SMD) 0.25; 95% confidence interval (CI) 0.06–0.45; seven trials; I 2 = 15%], and modest reduction in symptom burden (SMD −0.29; 95% CI −0.54–0.03; three trials; I 2 = 15%). There was no clear adverse impact on mortality. Most studies had methodological limitations that increased the risk of biases. Conclusion Compared to usual care, palliative care interventions substantially reduce hospitalizations, with no clear adverse effect on survival. Effects on QOL and symptom burden appear to be modest, and indicate that further efforts to improve these patient centred outcomes are needed.