Multi-disciplinary palliative care is effective in people with symptomatic heart failure: A systematic review and narrative synthesis

Sushma Datla, C.A. Verberkt, Angela Hoye, Daisy Janssen, Miriam J. Johnson

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Despite recommendations, people with heart failure have poor access to palliative care.

Aim: To identify the evidence in relation to palliative care for people with symptomatic heart failure.

Design: Systematic review and narrative synthesis. (PROSPERO CRD42016029911).

Data sources: Databases (Medline, Cochrane database, CINAHL, PsycINFO, HMIC, CareSearch Grey Literature), reference lists and citations were searched and experts contacted. Two independent reviewers screened titles and abstracts and retrieved papers against inclusion criteria. Data were extracted from included papers and studies were critically assessed using a risk of bias tool according to design.

Results: Thirteen interventional and 10 observational studies were included. Studies were heterogeneous in terms of population, intervention, comparator, outcomes and design rendering combination inappropriate. The evaluation phase studies, with lower risk of bias, using a multi-disciplinary specialist palliative care intervention showed statistically significant benefit for patient-reported outcomes (symptom burden, depression, functional status, quality of life), resource use and costs of care. Benefit was not seen in studies with a single component/discipline intervention or with higher risk of bias. Possible contamination in some studies may have caused under-estimation of effect and missing data may have introduced bias. There was no apparent effect on survival.

Conclusion: Overall, the results support the use of multi-disciplinary palliative care in people with advanced heart failure but trials do not identify who would benefit most from specialist palliative referral. There are no sufficiently robust multi-centre evaluation phase trials to provide generalisable findings. Use of common population, intervention and outcomes in future research would allow meta-analysis.
Original languageEnglish
Pages (from-to)1003-1016
Number of pages14
JournalPalliative Medicine
Volume33
Issue number8
DOIs
Publication statusPublished - Sep 2019

Keywords

  • Heart failure; hospice; palliative care; quality of life; systematic review.
  • Heart failure
  • STATEMENT
  • HOSPICE
  • COST-EFFECTIVENESS
  • MANAGEMENT
  • systematic review
  • palliative care
  • SOCIETY
  • TRIAL
  • DISEASE
  • QUALITY-OF-LIFE
  • hospice
  • quality of life
  • INTERVENTION
  • PROGRAM

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