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Which patients with heart failure should receive specialist palliative care?

Campbell, Ross T.; Petrie, Mark C.; Jackson, Colette E.; Jhund, Pardeep S.; Wright, Ann; Gardner, Roy S.; Sonecki, Piotr; Pozzi, Andrea; McSkimming, Paula; McConnachie, Alex; Finlay, Fiona; Davidson, Patricia; Denvir, Martin A.; Johnson, Miriam J.; Hogg, Karen J.; McMurray, John J.V.


Ross T. Campbell

Mark C. Petrie

Colette E. Jackson

Pardeep S. Jhund

Ann Wright

Roy S. Gardner

Piotr Sonecki

Andrea Pozzi

Paula McSkimming

Alex McConnachie

Fiona Finlay

Patricia Davidson

Martin A. Denvir

Karen J. Hogg

John J.V. McMurray


We investigated which patients with heart failure (HF) should receive specialist palliative care (SPC) by first creating a definition of need for SPC in patients hospitalised with HF using patient‐reported outcome measures (PROMs) and then testing this definition using the outcome of days alive and out of hospital (DAOH). We also evaluated which baseline variables predicted need for SPC and whether those with this need received SPC.

Methods and results
PROMs assessing quality of life (QoL), symptoms, and mood were administered at baseline and every 4 months. SPC need was defined as persistently severe impairment of any PROM without improvement (or severe impairment immediately preceding death). We then tested whether need for SPC, so defined, was reflected in DAOH, a measure which combines length of stay, days of hospital re‐admission, and days lost due to death. Of 272 patients recruited, 74 (27%) met the definition of SPC needs. These patients lived one third fewer DAOH than those without SPC need (and less than a quarter of QoL‐adjusted DAOH). A Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score of less than 29 identified patients who subsequently had SPC needs (area under receiver operating characteristic curve 0.78). Twenty‐four per cent of patients with SPC needs actually received SPC (n = 18).

A quarter of patients hospitalised with HF had a need for SPC and were identified by a low KCCQ score on admission. Those with SPC need spent many fewer DAOH and their DAOH were of significantly worse quality. Very few patients with SPC needs accessed SPC services.


Campbell, R. T., Petrie, M. C., Jackson, C. E., Jhund, P. S., Wright, A., Gardner, R. S., …McMurray, J. J. (2018). Which patients with heart failure should receive specialist palliative care?. European journal of heart failure, 20(9), 1338-1347.

Journal Article Type Article
Acceptance Date May 21, 2018
Online Publication Date Jun 28, 2018
Publication Date Sep 5, 2018
Deposit Date Jul 19, 2018
Publicly Available Date Oct 19, 2018
Print ISSN 1388-9842
Electronic ISSN 1879-0844
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 20
Issue 9
Pages 1338-1347
Keywords Heart failure, Palliative Care
Public URL
Publisher URL


Article (804 Kb)

Copyright Statement
© 2018 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.<br /> This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in<br /> any medium, provided the original work is properly cited.

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