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Palliative care in heart failure

A meta-analysis of randomized controlled trials

Palliativversorgung bei Herzinsuffizienz

Metaanalyse randomisierter kontrollierter Studien

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Abstract

Background

Palliative care can play an important role in the management of heart failure. We conducted a systematic review and meta-analysis to compare the efficacy and safety of palliative care in patients with heart failure.

Methods

PubMed, Embase, Web of Science, EBSCO, and the Cochrane Library databases were systematically searched. Randomized controlled trials (RCTs) on the impact of palliative care on heart failure were included. Two investigators independently searched the articles, extracted data, and assessed the quality of included studies. The primary outcome was mortality.

Results

Seven RCTs were included in the meta-analysis. Compared with usual care for heart failure, palliative care was associated with a significantly increased quality of life (standardized mean difference = 1.46; 95% confidence interval [CI] = 0.12 to 2.79; p = 0.03) and reduced depression scores (standardized mean difference = −0.62; 95% CI = −0.99 to −0.25; p = 0.03), but demonstrated no impact on mortality (risk ratio [RR] = 1.28; 95% CI = 0.86 to 1.92; p = 0.22) and rehospitalization (RR = 0.84; 95% CI = 0.66 to 1.07; p = 0.16).

Conclusion

Palliative care can improve the quality of life and reduce the occurrence of depression in patients with heart failure.

Zusammenfassung

Hintergrund

Die Palliativversorgung kann eine wichtige Rolle in der Behandlung der Herzinsuffizienz spielen. Die Autoren führten eine systematische Suche und eine Metaanalyse durch, um die Wirksamkeit und Sicherheit der Palliativversorgung bei Patienten mit Herzinsuffizienz zu vergleichen.

Methoden

Die Datenbanken PubMed, Embase, Web of Science, EBSCO und die Cochrane Library wurden systematisch durchsucht. In die Auswertung aufgenommen wurden randomisierte kontrollierte Studien (RCT) zum Einfluss der Palliativversorgung auf die Herzinsuffizienz. Unabhängig voneinander suchten 2 Untersucher die Artikel heraus, extrahierten Daten und beurteilten die Qualität der in die Auswertung eingeschlossenen Studien. Primärer Endpunkt war die Mortalität.

Ergebnisse

In die Metaanalyse wurden 7 RCT eingeschlossen. Im Vergleich zur gewöhnlichen Behandlung bei Herzinsuffizienz ging die Palliativversorgung mit einer signifikant erhöhten Lebensqualität einher (standardisierte Mittelwertsdifferenz = 1,46; 95%-Konfidenzintervall (KI) = 0,12–2,79; p = 0,03) sowie mit geringeren Depressionsscores (standardisierte Mittelwertsdifferenz = −0,62; 95%-KI = −0,99–−0,25; p = 0,03), zeigte jedoch keine Auswirkung auf die Mortalität (Risk Ratio [RR] = 1,28; 95%-KI = 0,86–1,92; p = 0,22) und eine erneute stationäre Aufnahme (RR = 0,84; 95%-KI = 0,66–1,07; p = 0,16).

Schlussfolgerung

Palliativversorgung kann die Lebensqualität verbessern und das Auftreten von Depressionen bei Patienten mit Herzinsuffizienz verringern.

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Authors and Affiliations

  1. Department Rehabilitation Medicine, Ningbo No. 2 Hospital, Ningbo, Zhejiang Province, China

    K. Zhou

  2. Emergency Department, Ninghai First Hospital, Ninghai, Zhejiang Province, China

    Y. Mao

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  1. K. Zhou
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Correspondence to Y. Mao.

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Conflict of interest

K. Zhou and Y. Mao declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Zhou, K., Mao, Y. Palliative care in heart failure. Herz 44, 440–444 (2019). https://doi.org/10.1007/s00059-017-4677-8

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