Palliative care for heart failure patients may lower rehospitalization risk and improve outcomes

New research published in the Journal of the American Heart Association indicates palliative care can significantly lower the risk of rehospitalization and the need for invasive procedures including mechanical ventilation and defibrillator implantation for heart failure patients.

Palliative care provides support to patients with chronic conditions to relieve symptoms and improve quality of life. Predominately occurring in the home, it focuses on pain relief and emotional support. As heart failure progresses, patients experience a high symptom burden that negatively impacts their ability to function, creates discomfort and increases risks of death. 

Neeraj Mendiratta, MD, volunteer medical expert for the American Heart Association and assistant physician in chief with Kaiser Permanente

“The COVID-19 pandemic has really highlighted the value of at-home care, including palliative care and home hospice care, for heart failure patients and aging populations. There’s a false perception that palliative and at-home care is only provided at the very end of life. However, palliative care can be beneficial for patients in any stage of a serious illness,” said palliative care expert, Neeraj Mendiratta, MD, volunteer medical expert for the American Heart Association and assistant physician in chief with Kaiser Permanente. “The need to manage care in a familiar, safe and comfortable environment is of increasing importance and can have a significant impact on patient outcomes and preserving healthcare resources.”

For Washington D.C. residents Beth and Charlie Peters, palliative care gave them and their son, Chris, peace of mind in managing Charlie’s heart failure symptoms and allowing them to stay in their home of 60 years. Prior to receiving specialized care, Chris, who currently lives in California, urged his parents to consider assisted living.

“We didn’t want to do that, particularly Charlie who loves and is comfortable and happy in his home,” Beth shared. “I was so fearful before we connected with Capital Caring that something awful would happen to him, and I’d have to call an ambulance. Knowing they’re there, I sleep at night, and my son is sleeping at night too.”

By 2030, the prevalence of heart failure will grow, resulting in millions of adults living with the condition, and a need for families to consider long-term care options.

Using data from the Veterans Affairs (VA) External Peer Review Program, researchers identified more than 57,000 patients who had been hospitalized for heart failure at one of the 124 VA medical centers between 2010 and 2015. Among those, 1,400 received palliative care prior to and during hospitalization for heart failure. Patients were matched for age, gender and similar health conditions and compared with the same number of patients in a control group who did not receive palliative care.

The study found:

  • Palliative care reduced rehospitalization rates. Overall, 31% of patients in the palliative care group experienced repeated hospital readmissions compared to 40% of patients in the control group.
  • The risks of mechanical ventilation and defibrillator implantation were significantly lower for palliative care patients (2.8% for palliative care versus 5.4% in the control group; and 2.1% for palliative care versus 3.6% in the control group, respectively).
  • After adjusting for hospital differences around the country, palliative care reduced hospital readmissions and being put on mechanical ventilation by about 25%.

“A team-based approach empowers patients and their loved ones to make difficult decisions about conditions like heart failure while prioritizing quality of life and what is most important to the patient and family,” said Dr. Mendiratta. 

Additional information on this study and resources on heart failure and palliative care are available in the American Heart Association newsroom.