Abstract 19509

Palliative Care and Hospital Readmissions in Patients With Advanced Heart Failure Insights From the PAL-HF Trial

Mentz, Robert J
Granger, Bradi B
Yang, Hongqiu
Anstrom, Kevin J
O’Connor, Christopher M
Patel, Chetan B
Fuzat, Mona
Dodson, Gwen
Adams, Patricia
Tulsky, James A
Rogers, joseph G

¹Duke Univ Sch of Medicine, Duke Clinical Rsch Institute, Durham, NC
²Heart Cntr, Duke Univ Sch of Nursing and Health System, Durham, NC
³Biostatistics, Duke Clinical Rsch Institute, Durham, NC
⁴Dept of Medicine, INOVA Heart & Vascular Institute, Falls Church, VA
⁵Dept of Medicine, Duke Clinical Rsch Institute, Durham, NC
⁶Dept of Medicine, Duke Univ and Health System, Durham, NC
⁷Duke Clinical Rsch Institute, Duke Univ and Health System, Durham, NC
⁸Chair, Dept of Psychosocial Oncology and Palliative Care, Harvard Med Sch, Boston, MA
⁹Vice Chair for Clinical Practice, Dept of Internal Medicine, Duke Univ Sch of Medicine, Durham, NC

Author Disclosures: R.J. Mentz: Research Grant; Modest; R01 NR013428/NR/NINR. B.B. Granger: Research Grant; Modest; R01 NR013428/NR/NINR. H. Yang: None. K.J. Anstrom: Research Grant; Modest; R01 NR013428/NR/NINR. C.M. O’Connor: Research Grant; Modest; R01 NR013428/NR/NINR. C.B. Patel: None. M. Fuzat: None. G. Dodson: None. P. Adams: None. J.A. Tulsky: Research Grant; Modest; R01 NR013428/NR/NINR. J.G. Rogers: Research Grant; Modest; R01 NR013428/NR/NINR.

Circulation 134(Suppl_1):p A19509, November 11, 2016.

Background: The PAL-HF trial intervention improved quality of life (QOL) compared to usual care in advanced heart failure (HF) patients. Patients with end-stage HF have a significant symptom burden that is often managed in the hospital despite patient preferences to reduce readmissions. Whether a palliative care intervention can reduce the burden of readmissions in advanced HF patients has not been well characterized.

Hypothesis: The PAL-HF intervention will be associated with a reduction in total readmissions and more days alive and out of the hospital (DAOH) over the 6 month follow-up period compared to usual care.

Methods: PAL-HF was a single center, randomized controlled trial of a multidisciplinary palliative care intervention compared to usual care in 150 patients with advanced HF (N=75 per study arm). We evaluated the total burden of all-cause readmissions and DAOH with the palliative care intervention compared to usual care.

Results: In PAL-HF, the median age was 72 (62-80) years, 47% were female, 41% were black, 48% had ischemic etiology and 55% had an EF</= 40%. Overall, 78 (52%) patients died and 73 (49%) were readmitted during the 6-month follow-up period without a significant between group difference by treatment assignment. The Table presents mortality and all-cause readmission data by treatment arm. Total readmissions were nominally lower in the intervention group than with usual care (61 vs. 69; p=0.135) with similar DAOH between groups (153 vs. 148; p=0.34).

Conclusion: A multidisciplinary, palliative care intervention that improved QOL resulted in a non-significant reduction in total readmissions and similar DAOH compared to usual care. Further work is needed to examine whether this intervention can be generalized to the broader population of advanced HF patients