Heart failure patients may suffer similarly to advanced cancer patients

Heart failure outpatients have similar numbers of symptoms and levels of depression and spiritual well-being as patients with advanced lung and pancreatic cancer, researchers reported at the American Heart Association’s 9th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

In their study, researchers from the University of Colorado Denver School of Medicine also found that heart failure patients with “poor” health status had greater symptoms and depression and worse spiritual well-being than patients with advanced cancer.

The study compared 60 ambulatory heart failure patients to 30 outpatients with advanced cancer being treated at Johns Hopkins Hospital or Bayview Medical Center in Baltimore, Md. Those with heart failure were outpatients, able to attend clinics and complete questionnaires.

“There has been a lot of attention on improving the quality of life and reducing suffering in cancer patients, but less on patients with heart failure,” said David Bekelman, M.D., M.P.H., lead author of the study. “Heart failure patients, particularly those with poor health status, need the option of palliative care.”

Palliative care — care devoted to improving quality of life and reducing suffering for patients with severe, life-threatening illnesses and their families — is often used to help advanced cancer patients.

Disease and death in chronic heart failure is high, with the average survival of 1.6 years after a hospitalization. Heart failure can have a major impact on a patient’s health status, contributing to symptom burden, functional limitations, and in turn depression, researchers said.

Researchers used the Memorial Symptom Assessment Scale-Short Form to assess symptom burden; Geriatric Depression Scale-Short Form for depression; Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale for spiritual well-being; and Kansas City Cardiomyopathy Questionnaire (KCCQ) for heart failure severity.

Researchers found no statistical difference among heart failure and cancer patients in measured physical symptoms, depression scores and spiritual well-being. The study also compared the same three parameters in heart failure patients with different ejection fractions. Ejection fraction is a common measure of heart function. Symptoms, depression and spiritual well-being were similar among heart failure patients with ejection fractions above and below 30, showing that while ejection fraction is a useful marker of heart failure severity, it did not correlate with quality of life domains.

However, heart failure patients with worse health status had a statistically greater number of physical symptoms (13.2 versus 8.6), higher depression scores (6.7 vs. 3.2) and lower spiritual well-being (29 vs. 38.9) than the cancer patients — even after adjusting for age, gender, marital status, education and income.

“The main finding was that patients with heart failure have a similar burden of symptoms, depression and low levels of spiritual well-being as advanced cancer patients,” said Bekelman, assistant professor of medicine at the University of Colorado Denver School of Medicine. “Advanced cancer patients are often quite sick and need care focused on quality of life in addition to care focused on the disease. We don’t usually think about providing similar care to outpatients with heart failure.”

“Patients with heart failure who are not at the end of life have palliative care needs,” Bekelman said. “But palliative care has been markedly under-used in heart failure patients.”

When researchers compared heart failure patients who had scores 50 or lower on the 100-point KCCQ (indicating poor health status) to the cancer patients, the heart failure patients had a statistically higher rate of symptoms and depression and a worse score on spiritual well-being.

Little research-based evidence exists to guide practitioners on which heart failure patients may benefit from palliative care. The study showed that KCCQ scores of under 50 can help identify patients who may benefit, Bekelman said.

“Heart failure patients’ symptoms such as shortness of breath, fatigue, pain, constipation and dry mouth can be improved with medical management,” he said. “Depression, which is common in patients with heart failure, can be treated with medications and counseling. Persistent symptoms can also contribute to depression, and treating persistent symptoms can help improve mood.”

“Clinicians should not underestimate the importance of using supportive communication and empathy with heart failure patients to reduce both symptoms and depression,” Bekelman said.

It may be helpful for physicians to get a chaplain or clergy member involved in the patient’s care to improve spiritual well-being, Bekelman said, noting that other approaches used to improve spiritual well-being in cancer patients, such as dignity therapy and meaning-centered psychotherapy, should also be evaluated for heart failure patients.

Source: American Heart Association

Related stories:

New study finds coronary arterial calcium scans help detect overall death risk in the elderly
Measuring calcium deposits in the heart's arteries can help predict overall death risk in American adults, even when they are elderly, according to a new study published in the July issue of Journal of the American College of Cardiology.
New online care for hypertension gets results
Controlling blood pressure at home, on Web, nearly doubles proportion of successful patients, JAMA study reports
Web-based care and at-home blood pressure checks can help control hypertension without office visits, according to the "e-BP" (Electronic Blood Pressure) study of more than 700 Group Health patients published in the June 25 Journal of the American Medical Association.
Certain anticancer agents could be harmful to patients with heart disease
A set of promising new anticancer agents could have unforeseen risks in individuals with heart disease, suggests research at Washington University School of Medicine in St. Louis. The anticancer drugs — which go by the strange name of hedgehog antagonists — interfere with a biochemical process that promotes growth in some cancer cells. But the researchers showed that interfering with this biochemical process in mice with heart disease led to further deterioration of cardiac function and ultimately death.
The Montreal Heart Institute presents findings on congestive heart failure and atrial fibrillation
Simpler approach to atrial fibrillation treatment in heart failure patients eliminates need for repeated cardioversions and reduces hospitalization rates
The results of a major international clinical trial coordinated by the Montreal Heart Institute were reported in the New England Journal of Medicine. The Atrial Fibrillation and Congestive Heart Failure Trial (AF-CHF) was a prospective, multicentre project involving patients with heart failure and atrial fibrillation.
First gene therapy for heart failure offered at NewYork-Presbyterian/Columbia
NYC's only medical center offering promising therapy as part of CUPID clinical trial
Could injecting a gene into a patient with severe heart failure reverse their disabling and life-threatening condition? Physician-scientists are setting out to answer that question in a first-ever clinical trial of gene therapy to treat severe heart failure.
Hearing loss is common in people with diabetes
Hearing loss is about twice as common in adults with diabetes compared to those who do not have the disease, according to a new study funded by the National Institutes of Health (NIH).
PET imaging detects early, 'silent heart' stage of disease in asymptomatic diabetic patients
As many as 50 percent of all cardiac deaths due to disease in the heart's vessels occur in individuals with no prior history or symptoms of heart disease. In addition, standard coronary risk factors may fail to explain up to 50 percent of cardiovascular events. Now, researchers using positron emission tomography (PET) are able to see changes in coronary blood vessels, offering hope that those at risk can receive earlier treatment and prolong life.
Serum sodium predicts mortality 10 times higher in PAH patients
Patients with pulmonary arterial hypertension (PAH)—chronically high blood pressure in the blood vessels of the lungs—whose serum sodium levels are low (called hyponatremia, or HN) have a very poor chance of survival and a high rate of right-heart failure (RHF), according to new research from the University of Pennsylvania.

News discussion:

Medicine & Health news