Specialist palliative care is helpful for people with advanced heart failure

What is it about?

We systematically searched for all the published literature looking at whether palliative care was helpful for people with advanced heart failure. We looked for randomised trials comparing the addition of palliative care to usual care versus usual care alone, and "before/after" reports of palliative care in addition to usual care. We found that when given as multidisciplinary (doctors, nurses, social workers etc.) care delivered by staff with extra training in palliative care (specialists), patients benefited (better symptoms, better quality of life, fewer hospital admissions...). However, the studies had some problems (patients unable to provide information during follow up, study intervention and usual care arm being available in the same institution risking some of the usual care also getting some intervention) and were mainly carried out in one study site only, limiting the confidence to say these findings are directly relevant to all other healthcare services and settings. Also, none of the studies tried to identify first which patients were most likely to need specialist palliative care and which could be managed well by the usual care team.

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Why is it important?

This paper pulls together the published literature on this subject. It gives a useful answer - yes, this care is beneficial when provided in this way. This gives a useful "evidence-marker" which identifies further important questions: I) which patients are most likely to benefit from specialist palliative care? ii) how can we best provide "usual care" palliative care as part of heart failure care for all and iii) what benefit do we find in larger, multi-site studies of interventions which take the other questions into account.