Palliative care for heart failure patients may lower rehospitalization risk and improve outcomes

May 27, 2020

DALLAS, May 27, 2020 -- Palliative care is valuable for heart failure patients, and, for those who are hospitalized, it can significantly lower the risk of repeated hospital admissions and the need for invasive procedures such as mechanical ventilation and defibrillator implantation, according to new research published today in the Journal of the American Heart Association, an open access journal of the American Heart Association.

Palliative care focuses on pain relief, emotional support and maximizing a patient's quality of life. Unlike hospice services, however, palliative care does not limit life-prolonging therapy. Yet continuing aggressive medical treatment is not always appropriate, especially when it eclipses a patient's most basic need - to make the most out of the time they have left.

As heart failure progresses, patients experience high symptom burden that negatively impacts their ability to function, creates suffering and increases risk of death. By 2030, the prevalence of heart failure will grow resulting in millions of adults living with the condition.

"There is a misunderstanding about when palliative care would be beneficial, even within the medical community. There's a perception that it's provided only at the very end of life, and that's not true," said James L. Rudolph, M.D., S.M., study co-author and the director of the Center of Innovation in Geriatric Services at the Providence VA Medical Center, professor of medicine at the Warren Alpert Medical School at Brown University and professor of health policy at Brown University School of Public Health in Providence, Rhode Island. "Palliative care added to heart failure treatment plans especially when a patient is hospitalized can have a big impact on the patient and the entire health system."

Using data from the Veterans Affairs (VA) External Peer Review Program, researchers identified more than 57,000 patients who had been hospitalized for heart failure at any of the 124 VA medical centers between 2010 and 2015. Among those, about 1,400 patients received palliative care prior to and during hospitalization for heart failure. Patients were matched for age, gender and similar health conditions with the same number of patients who did not receive palliative care (control group).

Researchers examined how often within six months after hospital discharge patients were readmitted, went to the intensive care unit and received procedures such as mechanical ventilation, pacemaker implantation or defibrillator implantation.

Researchers found:

Palliative care reduced the rates of multiple rehospitalizations. Overall, 31% of patients in the palliative care group experienced repeated hospital readmissions, compared to 40% of patients in the control group.

Mechanical ventilation and defibrillator implantation were significantly lower in the palliative care group (2.8% for palliative care versus 5.4% in the control group; and 2.1% for palliative care versus 3.6% in the control group, respectively).

After adjusting for hospital differences around the country, palliative care reduced the chance of hospital readmission or being put on mechanical ventilation by about 25%.

"Palliative care can be delivered along with aggressive heart failure treatment. In our study, palliative care patients still got defibrillators, went to the ICU and received mechanical ventilation," Rudolph said. "The team-based approach to palliative care seems to enable patients to make difficult decisions about life-limiting conditions such as heart failure."

The major limitation of this study is that patients receiving palliative care were a little older and sicker than those in the control group. Additionally, missing electronic medical record data varied by VA site.
Co-authors are Michelle S. Diop, M.D.; Garrett S. Bown B.S.; Jiang Lan, M.S.; Wen-Chih Wu, M.D., M.P.H.; and Pedro Gozalo, Ph.D.

The VA Health Services Research funded the study.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public's health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on, Facebook, Twitter or by calling 1-800-AHA-USA1.

American Heart Association

Related Heart Failure Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Read More: Heart Failure News and Heart Failure Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to