Symptom burden, psychosocial distress and palliative care needs in heart failure - A cross-sectional explorative pilot study.
Heart failure
Palliative care
Psychosocial distress
Symptom burden
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
received:
19
07
2021
accepted:
30
03
2022
pubmed:
15
4
2022
medline:
21
1
2023
entrez:
14
4
2022
Statut:
ppublish
Résumé
Beyond guideline-directed treatments aimed at improving cardiac function and prognosis in heart failure (HF), patient-reported outcomes have gained attention. Using a cross-sectional approach, we assessed symptom burden, psychosocial distress, and potential palliative care (PC) needs in patients with advanced stages of HF. At a large tertiary care center, we enrolled HF patients in an exploratory pilot study. Symptom burden and psychosocial distress were assessed using the MIDOS (Minimal Documentation System for Patients in PC) questionnaire and the Distress Thermometer (DT), respectively. The 4-item Patient Health Questionnaire (PHQ-4) was used to screen for anxiety and depression. To assess PC needs, physicians used the "Palliative Care Screening Tool for HF Patients". We included 259 patients, of whom 137 (53%) were enrolled at the Heart Failure Unit (HFU), and 122 (47%) at the outpatient clinic (OC). Mean age was 63 years, 72% were male. New York Heart Association class III or IV symptoms were present in 56%. With a mean 5-year survival 64% (HFU) vs. 69% (OC) calculated by the Seattle Heart Failure Model, estimated prognosis was comparatively good. Symptom burden (MIDOS score 8.0 vs. 5.4, max. 30 points, p < 0.001) and level of distress (DT score 6.0 vs. 4.8, max. 10 points, p < 0.001) were higher in hospitalised patients. Clinically relevant distress was detected in the majority of patients (HFU 76% vs. OC 57%, p = 0.001), and more than one third exhibited at least mild symptoms of depression or anxiety. Screening for PC needs revealed 82% of in- and 52% of outpatients fulfil criteria for specialized palliative support. Despite a good prognosis, we found multiple undetected and unaddressed needs in an advanced HF cohort. This study's tools and screening results may help to early explore these needs, to further improve integrated HF care.
Sections du résumé
BACKGROUND
BACKGROUND
Beyond guideline-directed treatments aimed at improving cardiac function and prognosis in heart failure (HF), patient-reported outcomes have gained attention.
PURPOSE
OBJECTIVE
Using a cross-sectional approach, we assessed symptom burden, psychosocial distress, and potential palliative care (PC) needs in patients with advanced stages of HF.
METHODS
METHODS
At a large tertiary care center, we enrolled HF patients in an exploratory pilot study. Symptom burden and psychosocial distress were assessed using the MIDOS (Minimal Documentation System for Patients in PC) questionnaire and the Distress Thermometer (DT), respectively. The 4-item Patient Health Questionnaire (PHQ-4) was used to screen for anxiety and depression. To assess PC needs, physicians used the "Palliative Care Screening Tool for HF Patients".
RESULTS
RESULTS
We included 259 patients, of whom 137 (53%) were enrolled at the Heart Failure Unit (HFU), and 122 (47%) at the outpatient clinic (OC). Mean age was 63 years, 72% were male. New York Heart Association class III or IV symptoms were present in 56%. With a mean 5-year survival 64% (HFU) vs. 69% (OC) calculated by the Seattle Heart Failure Model, estimated prognosis was comparatively good. Symptom burden (MIDOS score 8.0 vs. 5.4, max. 30 points, p < 0.001) and level of distress (DT score 6.0 vs. 4.8, max. 10 points, p < 0.001) were higher in hospitalised patients. Clinically relevant distress was detected in the majority of patients (HFU 76% vs. OC 57%, p = 0.001), and more than one third exhibited at least mild symptoms of depression or anxiety. Screening for PC needs revealed 82% of in- and 52% of outpatients fulfil criteria for specialized palliative support.
CONCLUSION
CONCLUSIONS
Despite a good prognosis, we found multiple undetected and unaddressed needs in an advanced HF cohort. This study's tools and screening results may help to early explore these needs, to further improve integrated HF care.
Identifiants
pubmed: 35420358
doi: 10.1007/s00392-022-02017-y
pii: 10.1007/s00392-022-02017-y
pmc: PMC9849173
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
49-58Informations de copyright
© 2022. The Author(s).
Références
J Am Coll Cardiol. 2017 Oct 10;70(15):1919-1930
pubmed: 28982506
J Am Coll Cardiol. 2009 Jul 28;54(5):386-96
pubmed: 19628112
Eur J Heart Fail. 2018 Sep;20(9):1338-1347
pubmed: 29952090
Clin Res Cardiol. 2019 Nov;108(11):1175-1196
pubmed: 31076853
J Oncol Pract. 2011 Nov;7(6):366-70
pubmed: 22379418
Trends Cardiovasc Med. 2018 Oct;28(7):445-450
pubmed: 29735287
Can J Cardiol. 2017 Nov;33(11):1342-1433
pubmed: 29111106
J Oncol Pract. 2015 Jan;11(1):e81-6
pubmed: 25392521
BMC Palliat Care. 2020 May 28;19(1):75
pubmed: 32466759
Circ Heart Fail. 2013 May;6(3):606-19
pubmed: 23616602
J Affect Disord. 2010 Apr;122(1-2):86-95
pubmed: 19616305
Eur J Cardiovasc Nurs. 2019 Dec;18(8):691-699
pubmed: 31319698
BMC Cardiovasc Disord. 2020 Dec 12;20(1):522
pubmed: 33308152
Schmerz. 2010 Dec;24(6):596-604
pubmed: 20882300
Lancet. 2018 Feb 10;391(10120):572-580
pubmed: 29174292
JACC Heart Fail. 2020 Mar;8(3):212-222
pubmed: 31838032
JACC Heart Fail. 2016 Mar;4(3):165-75
pubmed: 26874386
Card Fail Rev. 2017 Apr;3(1):7-11
pubmed: 28785469
Cancer. 1998 May 15;82(10):1904-8
pubmed: 9587123
J Palliat Med. 2015 Feb;18(2):134-42
pubmed: 25479182
J Palliat Med. 2018 Dec;21(12):1684-1689
pubmed: 30179523
J Am Coll Cardiol. 2019 Oct 15;74(15):1966-2011
pubmed: 31526538
JAMA. 2016 Nov 22;316(20):2104-2114
pubmed: 27893131
Eur J Heart Fail. 2013 Jul;15(7):717-23
pubmed: 23429975
Psychosomatics. 2009 Nov-Dec;50(6):613-21
pubmed: 19996233
Circulation. 2021 Jun;143(22):2129-2142
pubmed: 33906372
Interact Cardiovasc Thorac Surg. 2020 Dec 7;31(6):874-880
pubmed: 33155042
PLoS One. 2021 Mar 11;16(3):e0248240
pubmed: 33705486
Palliat Med. 2021 Jan;35(1):120-129
pubmed: 32912055
JCO Oncol Pract. 2021 Oct;17(10):e1584-e1591
pubmed: 33571007
J Am Coll Cardiol. 2006 Oct 17;48(8):1527-37
pubmed: 17045884
Circulation. 2018 Mar 20;137(12):e67-e492
pubmed: 29386200
Harv Rev Psychiatry. 2018 Jul/Aug;26(4):175-184
pubmed: 29975336
Eur Heart J. 2021 Sep 21;42(36):3599-3726
pubmed: 34447992
J Am Coll Cardiol. 2017 Jul 18;70(3):331-341
pubmed: 28705314
Circulation. 2006 Mar 21;113(11):1424-33
pubmed: 16534009
J Heart Lung Transplant. 2001 Sep;20(9):1016-24
pubmed: 11557198
ESC Heart Fail. 2020 Oct;7(5):2193-2207
pubmed: 32757363
ESC Heart Fail. 2014 Sep;1(1):4-25
pubmed: 28834669
Lancet. 2020 Oct 17;396(10258):1204-1222
pubmed: 33069326
JACC Heart Fail. 2020 Jun;8(6):429-440
pubmed: 32278679
J Heart Lung Transplant. 2013 Feb;32(2):157-87
pubmed: 23352391