Heart failure patients may suffer similarly to advanced cancer patients

“The main finding was that patients with heart failure have a similar burden of symptoms, depression and low levels of spiritual well-being as advanced cancer patients,” said Bekelman, assistant professor of medicine at the University of Colorado Denver School of Medicine. “Advanced cancer patients are often quite sick and need care focused on quality of life in addition to care focused on the disease. We don’t usually think about providing similar care to outpatients with heart failure.”

“Patients with heart failure who are not at the end of life have palliative care needs,” Bekelman said. “But palliative care has been markedly under-used in heart failure patients.”

When researchers compared heart failure patients who had scores 50 or lower on the 100-point KCCQ (indicating poor health status) to the cancer patients, the heart failure patients had a statistically higher rate of symptoms and depression and a worse score on spiritual well-being.

Little research-based evidence exists to guide practitioners on which heart failure patients may benefit from palliative care. The study showed that KCCQ scores of under 50 can help identify patients who may benefit, Bekelman said.

“Heart failure patients’ symptoms such as shortness of breath, fatigue, pain, constipation and dry mouth can be improved with medical management,” he said. “Depression, which is common in patients with heart failure, can be treated with medications and counseling. Persistent symptoms can also contribute to depression, and treating persistent symptoms can help improve mood.”

“Clinicians should not underestimate the importance of using supportive communication and empathy with heart failure patients to reduce both symptoms and depression,” Bekelman said.

It may be helpful for physicians to get a chaplain or clergy member involved in the patient’s care to improve spiritual well-being, Bekelman said, noting that other approaches used to improve spiritual well-being in cancer patients, such as dignity therapy and meaning-centered psychotherapy, should also be evaluated for heart failure patients.

Co-authors are: John S. Rumsfeld, M.D., Ph.D.; Edward P. Havranek, M.D.; Traci E. Yamashita, M.S.; Evelyn Hunt, M.D.; and Jean S. Kutner, M.D., M.S.P.H.

The study was funded by the Johns Hopkins Center for Complementary and Alternative Medicine; the Johns Hopkins General Clinical Research Center; and the National Center for Complimentary and Alternative Medicine, NIH.

Statements and conclusions of abstract authors presented at American Heart Association/American Stroke Association scientific meetings are solely those of the abstract authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability.

NR08-1051 (QCOR 08/Bekelman)