Heart failure patients may suffer similarly to advanced cancer patients

Abstract 171

Heart failure outpatients have similar numbers of symptoms and levels of depression and spiritual well-being as patients with advanced lung and pancreatic cancer, researchers reported at the American Heart Association’s 9th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

In their study, researchers from the University of Colorado Denver School of Medicine also found that heart failure patients with “poor” health status had greater symptoms and depression and worse spiritual well-being than patients with advanced cancer.

The study compared 60 ambulatory heart failure patients to 30 outpatients with advanced cancer being treated at Johns Hopkins Hospital or Bayview Medical Center in Baltimore, Md. Those with heart failure were outpatients, able to attend clinics and complete questionnaires.

“There has been a lot of attention on improving the quality of life and reducing suffering in cancer patients, but less on patients with heart failure,” said David Bekelman, M.D., M.P.H., lead author of the study. “Heart failure patients, particularly those with poor health status, need the option of palliative care.”

Palliative care — care devoted to improving quality of life and reducing suffering for patients with severe, life-threatening illnesses and their families — is often used to help advanced cancer patients.

Disease and death in chronic heart failure is high, with the average survival of 1.6 years after a hospitalization. Heart failure can have a major impact on a patient’s health status, contributing to symptom burden, functional limitations, and in turn depression, researchers said.

Researchers used the Memorial Symptom Assessment Scale-Short Form to assess symptom burden; Geriatric Depression Scale-Short Form for depression; Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale for spiritual well-being; and Kansas City Cardiomyopathy Questionnaire (KCCQ) for heart failure severity.

Researchers found no statistical difference among heart failure and cancer patients in measured physical symptoms, depression scores and spiritual well-being. The study also compared the same three parameters in heart failure patients with different ejection fractions. Ejection fraction is a common measure of heart function. Symptoms, depression and spiritual well-being were similar among heart failure patients with ejection fractions above and below 30, showing that while ejection fraction is a useful marker of heart failure severity, it did not correlate with quality of life domains.

However, heart failure patients with worse health status had a statistically greater number of physical symptoms (13.2 versus 8.6), higher depression scores (6.7 vs. 3.2) and lower spiritual well-being (29 vs. 38.9) than the cancer patients — even after adjusting for age, gender, marital status, education and income.