期刊
JOURNAL OF CARDIAC FAILURE
卷 22, 期 12, 页码 1033-1036出版社
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS
DOI: 10.1016/j.cardfail.2016.04.004
关键词
Palliative care; Heart failure; African American; Hospice
资金
- Blue Cross/Blue Shield Foundation of Michigan [1074-II PIRAP]
Background: Palliative interventions are an important part of advanced heart failure (HF) care. However, these interventions are historically underutilized, particularly by African Americans. Methods and Results: We performed a prospective randomized intervention trial in patients with advanced HF who were hospitalized for acute decompensation at 3 urban hospitals, comparing the effect of palliative care consultation (PCC) with that of usual care. The primary end point was the proportion choosing comfort-oriented care (hospice and/or do not resuscitate [DNR] order) 3-6 months after randomization. A total of 85 patients (mean age 68 years, 91.8% African American) were enrolled over a 2-year period. Four of the 43 patients (9.3%) randomized to the PCC group chose comfort-oriented care versus 0 of the 42 control group members (risk difference = 9.3%; 95% confidence interval = -11.8% to 30.0%). Conclusions: In this predominantly African-American cohort of hospitalized patients with advanced HF, PCC did not lead to a greater likelihood of comfort care election compared with usual care. More robust palliative interventions should be developed to meet the needs of diverse groups of patients with HF.
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