Multi-disciplinary palliative care is effective in people with symptomatic heart failure: a systematic review and narrative synthesis
Datla, Sushma; Verberkt, Cornelia Antonia; Hoye, Angela; Janssen, Daisy J. A.; Johnson, Miriam J.
Cornelia Antonia Verberkt
Daisy J. A. Janssen
Professor Miriam Johnson Miriam.Johnson@hull.ac.uk
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, 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 ten 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.
Conclusions: 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.
|Journal Article Type||Article|
|Publication Date||Sep 1, 2019|
|Peer Reviewed||Peer Reviewed|
|APA6 Citation||Datla, S., Verberkt, C. A., Hoye, A., Janssen, D., & Johnson, M. J. (2019). Multi-disciplinary palliative care is effective in people with symptomatic heart failure: a systematic review and narrative synthesis. Palliative medicine, 33(8), 1003-1016. https://doi.org/10.1177/0269216319859148|
|Keywords||Heart failure; Palliative care; Hospice; Systematic review; Quality of life|
©2019 The authors