Primary palliative care for heart failure provided within ambulatory cardiology: A randomized pilot trial.

Background: Heart failure is characterized by physical and emotional symptoms and decreased quality of life (QoL). Palliative care can reduce burdens of serious illness but often is limited to inpatient or academic settings.
Objectives: To develop and test the Primary Education for Nurses in Palliative care-HF (PENPal-HF) intervention, training outpatient cardiology nurses to address symptom burden, patient priorities for care and QoL, and advance care planning as part of quarterly HF visits.
Methods: We conducted a pilot randomized clinical trial for adults with NYHA Stage III or IV HF and ≥ 2 hospitalizations in the past 12 months, recruited from a community-based cardiology clinic. Participants were randomized 2:1, PENPal-HF plus usual care versus usual care alone. Primary outcomes were feasibility and acceptability.
Results: We randomized 30 adults with Stage III HF - 20 to PENPal-HF and 10 to usual care. Most in the intervention group (71%) and in the control group (62%) completed the study through the final outcome assessment in week 56; 5 participants died. Of 20 participants in the intervention, 14 (70%) remained in the study through the end of intervention visits; 11 (55%) completed all visits. Most intervention participants (93.75%) agreed or strongly agreed that they were satisfied with their care, and 87.5% agreed or strongly agreed that all people with HF should receive the intervention. Most intervention group participants (93.75%) reported a perceived improvement in physical symptoms, mood, and/or QoL.
Conclusions: This pilot study suggests that nurse-led primary palliative care in outpatient cardiology settings is promising. Research is warranted to determine efficacy and effectiveness.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Dio Kavalieratos reports financial support was provided by National Heart Lung and Blood Institute. Dio Kavalieratos reports a relationship with Cystic Fibrosis Foundation that includes: funding grants. Larry Allen reports a relationship with American Heart Association Inc that includes: funding grants. Larry Allen reports a relationship with National Institutes of Health that includes: funding grants. Larry Allen reports a relationship with Patient-Centered Outcomes Research Institute that includes: funding grants. Larry Allen reports a relationship with Boston Scientific Corp that includes: consulting or advisory. Larry Allen reports a relationship with Cytokinetics Inc that includes: consulting or advisory. Larry Allen reports a relationship with Novartis that includes: consulting or advisory. Larry Allen reports a relationship with UptoDate Inc that includes: consulting or advisory. Larry Allen reports a relationship with WCG that includes: consulting or advisory
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