Early Palliative Care Telehealth Intervention May Impact Pain in Patients With HF

Early palliative care telehealth interventions may not improve the quality of life for patients with heart failure but instead may improve both pain intensity and pain interference with daily life, according to new study results.

As national guidelines recommend early palliative care for patients with advanced heart failure, this study set out to examine the specific impacts of this specialized medical care over the usual medical care for these patients. The researchers examined the impact of this specialized care over 16 weeks in a number of areas, including quality of life, mood, pain, global health, and resource use of patients with advanced heart failure.

The single-blind, randomized clinical trial included 415 participants aged 50 years or older. All participants were previously diagnosed with New York Heart Association class 3 or class 4 heart failure or American College of Cardiology stage C or D heart failure. Participants were chosen from medical centers that consisted of high proportions of rural and minority populations, as these demographics are disproportionately affected by heart failure.

The researchers utilized several measurements in order to measure their primary and secondary outcomes. The primary outcomes included quality of life as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Functional Assessment of Chronic Illness Therapy-Palliative-14 (FACIT-Pal-14) and mood as measured by the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes included global health as measured by Patient Reported Outcome Measurement System Global Health, pain as measured by Patient Reported Outcome Measurement System Pain Intensity and Interference, and resource use as measured by hospital and emergency department visits.

The 415 participants were randomly assigned into 2 groups: early palliative care through ENABLE CHF-PC intervention (n=208) or usual care (n=207). Of the 415 participants, 221 were men, 226 (54.5%) were African American, 108 (26.0%) lived in a rural area, and 190 (45.8%) had a high-school education or less.

At week 16, the mean KCCQ score improved 3.9 points in the intervention group vs 2.3 in the usual care group, and the mean FACIT-Pal-14 score improved 1.4 points in the intervention group vs 0.2 points in the usual care group. There were no notable differences in mood between the groups.

“This randomized clinical trial with a majority African American sample and baseline good quality of life did not demonstrate improved quality of life or mood with a 16-week early palliative care telehealth intervention. However, pain intensity and interference (secondary outcomes) demonstrated a clinically important improvement,” the researchers concluded.

—Leigh Precopio

Reference:

Bakitas MA, Dionne-Odom JN, Ejem DB, et al. Effect of an early palliative care telehealth intervention vs usual care on patients with heart failure: the ENABLE CHF-PC randomized clinical trial. JAMA Intern Med. 2020;180(9):1203-1213. doi:10.1001/jamainternmed.2020.2861