Similar Need for Palliative Care Seen in Heart Failure and Advanced Cancer

May 02, 2008

May 2, 2008 (Baltimore, MD) - Patients with heart failure and those with advanced malignancies are similarly burdened by symptoms, depression, and quality-of-life issues that can be addressed by care providers, with the need significantly greater among the most debilitated patients with heart failure, according to a small observational study [1].

"Most of what's done in palliative care these days is directed toward people with cancer," Dr David Bekelman (University of Colorado at Denver Health Sciences Center, Aurora) observed for heartwire . "Perhaps we can do more to reduce the burden of heart failure on patients. We're really good at pain management, but it's important to know that the patients suffer in a variety of ways that doctors can potentially help with."

At a session here today at the American Heart Association 2008 Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Conference, Bekelman presented his group's analysis of 60 outpatients with NYHA class 2-4 heart failure and 30 with advanced, unresectable non–small-cell lung cancer or pancreatic adenocarcinoma. They found that questionnaire scores for symptom severity, depression, and "spiritual well-being" were similar for both groups of patients. Worst off was the subgroup of heart-failure patients with the poorest clinical status, as defined by a score <50 on the Kansas City Cardiomyopathy Questionnaire (KCCQ).

Mean Scores for All Heart-Failure Patients, the Subset With More Advanced Heart Failure, and All Cancer Patients

Parameter All Heart Failure, n=60 Advanced Heart Failure, n=17 Advanced Cancer, n=30 pa
Symptom scoreb 9.1 13.2 8.6 0.03
Depression scorec 3.9 6.7 3.2 0.001
Spiritual well-beingd 35.9 29.0 38.9 <0.01

a. Advanced heart failure vs advanced cancer
b. Memorial Symptom Assessment Scale--Short Form (higher score=more symptoms)
c. Geriatric Depression Scale--Short Form (score=number of symptoms)
d. Functional Assessment of Chronic Illness Therapy--Spiritual Well-Being Scale (higher score=better well-being)

 

Perhaps heart-failure patients tend to get less palliative care than cancer patients in part because there is often less certainty about their prognosis, according to Bekelman. "Heart failure has a much different illness trajectory. There are a lot of ups and downs. [The patients] can die at any time from sudden cardiac death, or they can enter the hospital critically ill and then sometimes they recover," he said. "That's a major illness-related barrier to providing palliative care."

Although there's been little study of ways to identify which heart-failure patients are most in need of such care, the KCCG might be helpful, the study suggests. Clinicians can be vigilant for symptoms of depression and could, as needed, steer patients toward antidepressant therapy or counseling, Bekelman proposed. "Maybe asking patients how the condition is affecting them in their life and relationships can get at some of the spiritual issues."

  1. Bekelman D, Rumsfeld J, Havranek E, et al. Symptom burden, depression, and spiritual well-being: A comparison of heart failure and advanced cancer patients. Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Conference 2008; May 2, 2008; Baltimore, MD. Abstract 171.

The complete contents of Heartwire , a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.

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