Results of a Hospital Based Palliative- Care Intervention for Patients with an Acute Exacerbation of Chronic Heart Failure

Abstract Background Palliative interventions are an important part of advanced heart failure (HF) care. However, these interventions are historically underutilized, particularly by African Americans. Methods and Results We performed a prospective, randomized intervention trial in patients with advanced HF who were hospitalized for acute decompensation at three urban hospitals, comparing the effect of palliative care consultation (PCC) with usual care. The primary end-point was the proportion choosing comfort oriented care (hospice and/or DNR) between three and six months post-randomization. A total of 85 patients (91.8% African American; mean age 68 years) were enrolled over a two-year period. Four of the 43 (9.3%) patients randomized to the PCC group chose comfort oriented care, versus 0 of the 42 control group members (risk difference=9.3%; 95% confidence interval = -11.8% to 30.0%). Conclusions In this predominantly African American cohort of hospitalized patients with advanced HF, PCC did not lead to a greater likelihood of comfort care election compared with usual care. More robust palliative interventions should be developed to meet the needs of diverse groups of patients with HF.