Integrating the palliative care principles of shared decision making and advance care planning into heart failure management : a pilot project

Integrating the Palliative Care Principles of Shared Decision Making and Advance Care Planning into Heart Failure Management: A Pilot Project Heart failure (HF) is a complex clinical syndrome associated with a high mortality rate, frequent hospitalizations, and significant symptom burden that often contributes to a poor quality of life. Palliative care (PC), historically associated with managing the end- of-life needs of cancer patients, offers opportunities to improve health-related quality of life for those with HF in conjunction with, or instead of, life-prolonging medical therapies. The aim of this project was to evaluate and address patient-specific needs for those with advanced HF. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was administered to patients recently hospitalized for acutely decompensated heart failure who were referred to a hospital-affiliated heart failure clinic for ongoing disease management. Of 26 questionnaires administered, 10 patients met inclusion criteria and agreed to participate. These patients were randomly allocated in a 1:1 fashion to one of two groups, with either usual care or usual care plus PC intervention. All received guideline-directed HF treatment; the intervention group also participated in one-on-one semi-structured interviews with a nurse practitioner experienced in both HF management and PC. After three months, patients were re-evaluated with the KCCQ, and baseline and 3-month results were compared and analyzed using the Wilcoxon signed-ranked test. Although no statistically significant change was noted, clinically significant change was found through validated KCCQ score changes in both groups. This project emphasized the need for concurrent guideline-directed HF therapy and palliative interventions. Long- term, consistent care is essential for this patient population to achieve patient-centered care that is congruent with their needs and wishes. Keywords: Heart failure, palliative care, shared decision-making, health-related quality of life, patient-centered care, advance care planning