Patterns of Change in Quality of Life with a Palliative Care Intervention for Patients with Advanced Heart Failure: Insights from PAL-HF

The PAL-HF trial demonstrated that palliative care improves quality of life (QOL) in advanced heart failure (HF) patients as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ). Less is known about how palliative care affects specific domains which comprise the KCCQ overall summary score. Moreover, while a 5-pt change is commonly used to characterize clinical significance, this magnitude of change may have different implications based on where patients begin and end. We hypothesized that palliative care would impact individual KCCQ domains differently (i.e.
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Tags: 427 Source Type: research

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Abstract OBJECTIVE: In seriously ill cardiac patients, several psychotherapy efficacy studies demonstrate little to no reduction in depression or improvement in quality of life, and little is known about how to improve psychotherapies to best address the range of patient needs. An interpersonal and behavioral activation psychotherapy was a key component of the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) multisite randomized clinical trial. Although depressive symptoms did improve in the CASA trial, questions remain about how best to tailor psychotherapies to the needs of seriously ill pat...
Source: Palliative and Supportive Care - Category: Palliative Care Authors: Tags: Palliat Support Care Source Type: research
A 63-year-old man with end-stage ischemic cardiomyopathy presented with incessant ventricular tachycardia. He had been hospitalized multiple times in the past year for severe heart failure. As he approached end of life and was regularly receiving defibrillator shocks, his care team recommended deactivation of his implantable cardioverter-defibrillator. However, his family did not wish to allow deactivation, reporting a religious obligation to prolong his life, regardless of the risk of suffering.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Tags: Ethical Issues in Palliative Care Source Type: research
It is a matter of course that palliative care is important for the patients with terminal heart failure as well as terminal cancer. But heart failure is gradually getting worse while the patients repeatedly get hospitalized, so the timing of starting palliative care is difficult. In our hospital, last year 337 patients were hospitalized and 14 patients died for heart failure. We established heart failure palliative care team in 2016, and holded malti-disciplinary conference about terminal heart failure patients once a week.
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Source Type: research
uml;m M Abstract BACKGROUND: To explore the relationships between anaemia or iron deficiency (ID) and symptoms, quality of life (QoL), morbidity, and mortality. METHODS: A post-hoc, non-prespecified, explorative substudy of the prospective randomized PREFER trial. One centre study of outpatients with severe HF and palliative need managed with advanced home care. Associations between anaemia, ID, and the Edmonton Symptom Assessment Scale (ESAS), Euro QoL (EQ-5D), Kansas City Cardiomyopathy Questions (KCCQ) were examined only at baseline but at 6months for morbidity and mortality. RESULTS: Seventy-two pati...
Source: European Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Eur J Intern Med Source Type: research
Background: Chronic intravenous inotropy is used as palliation therapy in patients with advanced heart failure (HF) who are not candidates for a left ventricular assist device or heart transplantation. However, the ultimate outcome of such patients is underreported. The purpose of this study was to describe the outcome of patients with advanced HF discharged on home inotropy. Methods: We carefully followed 14 patients that were discharged on palliative inotropes from June 2014 to November 2016. Median age was 69 years, 57% were males and 64% had non-ischemic dilated cardiomyopathy.
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Source Type: research
The main results of PAL-HF - a randomized, controlled trial of specialty palliative care team involvement in advanced heart failure patients -  have just been published in the Journal of the American College of Cardiology (DOI: 10.1016/j.jacc.2017.05.030. Clinicaltrials.gov registration here). This is an important, well-done study, with encouraging results - specialty PC improved the quality of life of patients with HF. I'll discuss the results in more details in this post.The study was done by a multi-disciplinary team of palliative&cardiology investigators at Duke. This week's publi...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: chf heart failure research research issues rosielle Source Type: blogs
This study assessed the prevalence of grey hair in patients with coronary artery disease and whether it was an independent risk marker of disease. This was a prospective, observational study which included 545 adult men who underwent multi-slice computed tomography (CT) coronary angiography for suspected coronary artery disease. Patients were divided into subgroups according to the presence or absence of coronary artery disease, and the amount of grey/white hair. The amount of grey hair was graded using the hair whitening score: 1 = pure black hair, 2 = black more than white, 3 = black equals white, 4 = white more t...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
Milrinone is a phosphodiesterase 3 inhibitor with both positive inotropic and vasodilator properties. Administered as a continuous infusion, milrinone is indicated for the short-term treatment of patients with acute decompensated heart failure. Despite limited data supporting long-term milrinone therapy in adults with congestive heart failure, children managed as outpatients may benefit from continuous milrinone as a treatment for cardiac dysfunction, as a destination therapy for cardiac transplant, or as palliative therapy for cardiomyopathy. The aim of this article is to review the medical literature and describe a home ...
Source: Journal of Infusion Nursing - Category: Nursing Tags: Features Source Type: research
There is an unmet need to establish palliative home healthcare system for patients suffering from end-stage heart failure (HF). Here we report a case of successful palliative home care with continuous dobutamine infusion. The patient was a 71-year-old man, having severe left ventricular dysfunction due to idiopathic dilated cardiomyopathy diagnosed at the age of 53. Despite the optimal medical therapy, cardiac resynchronization therapy and cardiac rehabilitation, his cardiac function gradually worsened.
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Source Type: research
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 7. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
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