Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial.
Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial.
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DOI：
10.1016/j.jacc.2017.05.030
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发表时间：
2017-07-18
影响因子：
24
通讯作者：
Tulsky JA
中科院分区：
文献类型：
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作者：
Rogers JG;Patel CB;Mentz RJ;Granger BB;Steinhauser KE;Fiuzat M;Adams PA;Speck A;Johnson KS;Krishnamoorthy A;Yang H;Anstrom KJ;Dodson GC;Taylor DH Jr;Kirchner JL;Mark DB;O'Connor CM;Tulsky JA
晚期心力衰竭（HF）的特点是发病率和死亡率高。常规疗法可能不足以减少患者的痛苦并最大限度地提高生活质量。.我们调查了除了循证HF护理外，跨学科姑息治疗干预是否改善了某些结局。我们将2012年8月15日至2015年6月25日期间的150例晚期HF患者随机分配至单中心常规治疗（UC; n =75）或UC+姑息治疗干预（UC+PAL; n =75）。主要终点为2项生活质量测量，即6个月时评估的堪萨斯城心肌病问卷（KCCQ）总体总结和慢性病治疗-姑息治疗量表的功能评估（FACIT-量表）。次要终点包括抑郁和焦虑评估（通过医院焦虑和抑郁量表[HADS]测量）、精神健康（通过FACIT -精神健康量表[FACIT-Sp]测量）、住院和死亡率。从随机化至6个月，随机分配至UC+PAL组与UC单药组的患者的KCCQ和FACIT-Risk评分出现具有临床意义的增量改善（KCCQ差异=9.49分，95% CI 0.94 - 18.05，p =0.030; FACIT-Risk差异=11.77分，95% CI 0.84 - 22.71，p =0.035）。UC+PAL患者（HADS-抑郁差异=-1.94分; p =0.020）与UC单独患者相比抑郁改善，焦虑结果相似（HADS-焦虑差异=-1.83分; p =0.048）。UC+PAL患者的精神幸福感较UC单药患者有所改善（FACIT-Sp差异=3.98分; p =0.027）。随机分配至UC+PAL不影响再住院或死亡率。在晚期HF患者中进行的跨学科姑息治疗干预在生活质量、焦虑、抑郁和精神健康方面的获益始终大于单独UC。ClinicalTrials.gov标识符：NCT 01589601
Advanced heart failure (HF) is characterized by high morbidity and mortality. Conventional therapy may not sufficiently reduce patient suffering and maximize quality of life. . We investigated whether an interdisciplinary palliative care intervention in addition to evidence-based HF care improves certain outcomes. We randomized 150 patients with advanced HF between August 15, 2012, and June 25, 2015, to usual care (UC; n =75) or UC plus a palliative care intervention (UC+PAL; n =75) at a single center. Primary endpoints were 2 quality-of-life measurements, the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary and the Functional Assessment of Chronic Illness Therapy - Palliative Care scale (FACIT-Pal), assessed at 6 months. Secondary endpoints included assessments of depression and anxiety (measured via the Hospital Anxiety and Depression Scale [HADS]), spiritual well-being (measured via the FACIT - Spiritual Well-Being scale [FACIT-Sp]), hospitalizations, and mortality. Patients randomized to UC+PAL versus UC alone had clinically significant incremental improvement in KCCQ and FACIT-Pal scores from randomization to 6 months (KCCQ difference =9.49 points, 95% CI 0.94 to 18.05, p =0.030; FACIT-Pal difference =11.77 points, 95% CI 0.84 to 22.71, p =0.035). Depression improved in UC+PAL patients (HADS-depression difference =−1.94 points; p =0.020) versus UC-alone patients, with similar findings for anxiety (HADS-anxiety difference =−1.83 points; p =0.048). Spiritual well-being was improved in UC+PAL versus UC-alone patients (FACIT-Sp difference =3.98 points; p =0.027). Randomization to UC+PAL did not affect rehospitalization or mortality. An interdisciplinary palliative care intervention in advanced HF patients showed consistently greater benefits in quality of life, anxiety, depression, and spiritual well-being compared with UC alone. ClinicalTrials.gov Identifier: NCT01589601