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Invited Commentary
July 27, 2020

Improving the Integration of Palliative Care in Heart Failure—It’s Hard to Hit a Moving Target

Author Affiliations
  • 1Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2James J. Peters VA Medical Center, Bronx, New York
JAMA Intern Med. 2020;180(9):1213-1214. doi:10.1001/jamainternmed.2020.2855

In this issue of JAMA Internal Medicine, Bakitas and colleagues report the results of their nurse-led trial to improve outcomes in patients with advanced heart failure (HF).1 This study builds on their previous work on project ENABLE (Educate, Nurture, Advise, Before Life Ends), a palliative care telehealth intervention for patients with advanced cancer, which has been shown to improve quality of life and mood.2 The investigators have adapted their original cancer-based ENABLE intervention to create ENABLE CHF-PC (Educate, Nurture, Advise Before Life Ends Comprehensive Heartcare for Patients and Caregivers) to help patients with advanced HF cope with their serious illness. The intervention involves a combination of in-person palliative care consultations, nurse coaching sessions via telehealth using a structured workbook as a guide, and ongoing monthly follow-up telephone calls to reinforce the content. Topics covered include improving patients’ understanding of their illness, delivering self-care, addressing physical and emotional symptoms, advance care planning, and creating legacy materials. They enrolled 415 patients who were randomized to the intervention or usual care control. The participants were followed up for 48 weeks to determine whether the intervention improved the primary outcomes of quality of life and mood as well as the secondary outcomes of overall global health, including scales associated with pain, and resource use (numbers of hospital days and emergency department visits). Their intention-to-treat analysis demonstrated that the intervention had no significant effects on the quality of life or mood outcomes in the overall population, but there was a significant improvement in pain intensity and pain interference. There were no changes in resource use.

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