Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial.

Background: Advanced heart failure (HF) is characterized by high morbidity and mortality. Conventional therapy may not sufficiently reduce patient suffering and maximize quality of life.

Objectives: The authors investigated whether an interdisciplinary palliative care intervention in addition to evidence-based HF care improves certain outcomes.

Usefulness of Palliative Care to Complement the Management of Patients on Left Ventricular Assist Devices.

Within the last decade, advancements in left ventricular assist device therapy have allowed patients with end-stage heart failure (HF) to live longer and with better quality of life. Like other life-saving interventions, however, there remains the risk of complications including infections, bleeding episodes, and stroke. The candidate for left ventricular assist device therapy faces complex challenges going forward, both physical and psychological, many of which may benefit from the application of palliative care principles by trained specialists.

The palliative care in heart failure trial: rationale and design.

Background: The progressive nature of heart failure (HF) coupled with high mortality and poor quality of life mandates greater attention to palliative care as a routine component of advanced HF management. Limited evidence exists from randomized, controlled trials supporting the use of interdisciplinary palliative care in HF.

Methods: PAL-HF is a prospective, controlled, unblinded, single-center study of an interdisciplinary palliative care intervention in 200 patients with advanced HF estimated to have a high likelihood of mortality or rehospitalization in the ensuing 6 months.

Discordance between patient-predicted and model-predicted life expectancy among ambulatory patients with heart failure.

Context: Patients with chronic heart failure have impaired long-term survival, but their own expectations regarding prognosis have not been well studied.

Objectives: To quantify expectations for survival in patients with heart failure, to compare patient expectations to model predictions, and to identify factors associated with discrepancies between patient-predicted and model-predicted prognosis.

Design, Setting, And Participants: Prospective face-to-face survey of patients from the single-center Duke Heart Failure Disease Management Program between July and December 2004, with follow-up through February 2008.