title: Inpatient palliative care for patients with acute heart failure: outcomes from a randomized trial.
abstract: BACKGROUND
  Heart failure (HF) is associated with a high symptom burden and reduced quality of life (QOL). Models integrating palliative care (PC) into HF care have been proposed, but limited research is available on the outcomes of such models.
  
  
  OBJECTIVE
  Our aim was to assess if inpatient PC for HF patients is associated with improvements in symptom burden, depressive symptoms, QOL, or differential use of services.
  
  
  METHODS
  Patients hospitalized with acute HF were randomized to receive a PC consult with follow-up as determined by provider or standard care. Two hundred thirty-two patients (116 intervention/116 control) from a large tertiary-care urban hospital were recruited over a 10-month period. Primary outcomes were symptom burden, depressive symptoms, and QOL measured at baseline, 1, and 3 months. Secondary outcomes included advance care planning (ACP), inpatient 30-day readmission, hospice use, and death.
  
  
  RESULTS
  Improvements were greater at both 1 and 3 months in the intervention group for primary outcome summary measures after adjusting for age, gender, and marital status differences between study groups. QOL scores increased by 12.92 points in the intervention and 8 points in the control group at 1 month (difference+4.92, p<0.001). Improvement in symptom burden was 8.39 in the intervention group and 4.7 in the control group at 1 month (+3.69, p<0.001). ACP was the only secondary outcome associated with the intervention (hazard ratio [HR] 2.87, p=0.033).
  
  
  CONCLUSIONS
  An inpatient PC model for patients with acute HF is associated with short-term improvement in symptom burden, QOL, and depressive symptoms.
authors.affiliation: 1 Division of Applied Research, Allina Health , Minneapolis, Minnesota.
authors.forename: Abbey C
authors.initials: AC
authors.lastname: Sidebottom
authors.forename: Ann
authors.initials: A
authors.lastname: Jorgenson
authors.forename: Hallie
authors.initials: H
authors.lastname: Richards
authors.forename: Justin
authors.initials: J
authors.lastname: Kirven
authors.forename: Arthur
authors.initials: A
authors.lastname: Sillah
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000451:nursing*; D005260:Female; D006333:Heart Failure / Q000451:nursing*; D006786:Hospitals, Urban; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D016294:Models, Nursing; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D012017:Referral and Consultation; D012737:Sex Factors; D012959:Socioeconomic Factors; D062606:Tertiary Care Centers; D016896:Treatment Outcome