title: Palliative Care Interventions for Patients with Heart Failure: A Systematic Review and Meta-Analysis.
abstract: To systematically characterize interventions and effectiveness of palliative care for advanced heart failure (HF) patients.
  
  
  
  Patients with advanced heart failure experience a high burden of distressing symptoms and diminished quality of life. Palliative care expertise with symptom management and healthcare decision-making benefits HF patients.
  
  
  
  A systematic PubMed search was conducted from inception to June 2016 for studies of palliative care interventions for HF patients. Studies of humans with a HF diagnosis who underwent a palliative care intervention were included. Data were extracted on study design, participant characteristics, intervention components, and in three groups of outcomes: patient-centered outcomes, quality-of-death outcomes, and resource utilization. Study characteristics were examined to determine if meta-analysis was possible.
  
  
  
  The fifteen identified studies varied in design (prospective, n = 10; retrospective, n = 5). Studies enrolled older patients, but greater variability was found for race, sex, and marital status. A majority of studies measuring patient-centered outcomes demonstrated improvements including quality of life and satisfaction. Quality-of-death outcomes were mixed with a majority of studies reporting clarification of care preferences, but less improvement in death at home and hospice enrollment. A meta-analysis in three studies found that home-based palliative care consults in HF patients lower the risk of rehospitalization by 42% (RR = 0.58; 95% Confidence Interval 0.44, 0.77).
  
  
  
  Available evidence suggests that home and team-based palliative interventions for HF patients improve patient-centered outcomes, documentation of preferences, and utilization. Increased high quality studies will aid the determination of the most effective palliative care approaches for the HF population.
authors.affiliation: 1 Primary Care and Population Medicine Program, Warren Alpert Medical School of Brown University , Providence, Rhode Island.|2 Center of Innovation for Long Term Services and Supports , Providence VAMC, Providence, Rhode Island.
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Diop
authors.affiliation: 2 Center of Innovation for Long Term Services and Supports , Providence VAMC, Providence, Rhode Island.|3 Department of Medicine, Warren Alpert Medical School of Brown University , Providence, Rhode Island.|4 Center for Gerontology, Brown University School of Public Health , Providence, Rhode Island.
authors.forename: James L
authors.initials: JL
authors.lastname: Rudolph
authors.affiliation: 5 Department of Pharmacotherapy and Outcomes, Virginia Commonwealth University , Richmond, Virginia.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Zimmerman
authors.affiliation: 6 Department of Obstetrics and Gynecology, Tulane University School of Medicine , New Orleans, Louisiana.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Richter
authors.affiliation: 7 Division of Geriatrics and Palliative Care, VA Boston Healthcare System , Boston, Massachusetts.|8 Harvard Medical School , Boston, Massachusetts.
authors.forename: L Michal
authors.initials: LM
authors.lastname: Skarf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies
keywords: cultural care; heart failure; palliative care; quality of life; symptoms; utilization