A systematic review of the evidence in support of palliative care in people with persistently symptomatic heart failure

Datla, Sushma

July 2016

Thesis or dissertation

© 2016 Sushma Datla. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

Background: Heart failure is common. People with advanced stages of the disease are symptomatic and have poor quality of life. Despite recommendations, this population have little access to palliative care. A barrier for people with heart failure accessing palliative care is clinicians' perceptions that there is little or no evidence to show that palliative care is beneficial in this patient group.

Aim: The thesis aims is to identify the evidence in support of palliative care in heart failure management.

Methods: A systematic review was conducted of the current evidence in support of palliative care in people with persistently symptomatic heart failure. Medline, Cochrane database, CINAHL, PsycINFO, HMIC, Care Search Grey Literature, reference lists, and citations were searched and experts were emailed for studies about 'persistently symptomatic heart failure' and 'palliative care'.

Results: Two researchers screened 7,005 titles and abstracts independently. Seven phase III trials, one phase II trial, one non-randomised quasi-experimental trial, five cohort studies, and one case-control study were included. Studies were heterogeneous in terms of population, intervention, comparator, and outcomes. However, study designs with adequate power and a multi-disciplinary palliative care intervention showed benefit for a variety of patient-reported outcomes such as symptom burden, depression, functional status, and quality of life, as well as, administrative outcomes such as resource use and costs of care.

Discussion: Overall, the results support the use of palliative care in managing patients with heart failure; however, findings were not consistent across all studies. Various methodological issues may contribute to discrepant results, and effect may have been under-estimated in several studies due to risk of contamination of controls. Further research is needed to understand which patients would benefit most from general and specialist palliative care.

Hull York Medical School, The University of Hull and University of York
Johnson, Miriam (Miriam J.)
Qualification level
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