title: 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.
  
  
  RESULTS
  We performed a prospective randomized intervention trial in patients with advanced HF who were hospitalized for acute decompensation at 3 urban hospitals, comparing the effect of palliative care consultation (PCC) with that of usual care. The primary end point was the proportion choosing comfort-oriented care (hospice and/or "do not resuscitate" [DNR] order) 3-6 months after randomization. A total of 85 patients (mean age 68 years, 91.8% African American) were enrolled over a 2-year period. Four of the 43 patients (9.3%) 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.
authors.affiliation: School of Social Work, Wayne State University, Detroit, Michigan. Electronic address: faithhopp@wayne.edu.
authors.forename: Faith P
authors.initials: FP
authors.lastname: Hopp
authors.affiliation: Department of Emergency Medicine, Division of Palliative Care, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Zalenski
authors.affiliation: Department of Emergency Medicine, Division of Palliative Care, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Denise
authors.initials: D
authors.lastname: Waselewsky
authors.affiliation: Palliative Care Nurse Practitioner, Sinai-Grace Hospital, Detroit Medical Center, Detroit, Michigan.
authors.forename: Jeri
authors.initials: J
authors.lastname: Burn
authors.affiliation: Social Work Department, University of Michigan-Flint, Flint, Michigan.
authors.forename: Jessica
authors.initials: J
authors.lastname: Camp
authors.affiliation: Department of Emergency Medicine and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Welch
authors.affiliation: Department of Emergency Medicine and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Phillip
authors.initials: P
authors.lastname: Levy
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000208:ethnology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D000070659:Patient Comfort; D057240:Patient Preference; D010865:Pilot Projects; D011446:Prospective Studies; D012017:Referral and Consultation; D016896:Treatment Outcome
keywords: African American; Heart failure; Hospice; Palliative care