Collaborative, home-based palliative care can improve end-of-life outcomes for people with chronic heart failure

Collaborative, home-based palliative care can improve end-of-life outcomes for people with chronic heart failure

Chronic heart failure patients who received collaborative, home-based palliative care were less likely to die in hospital and more likely to die at home than people who received usual care, according to a new study in CMAJ (Canadian Medical Association Journal). https://www.cmaj.ca/lookup/doi/10.1503/cmaj.220784.

In Ontario, 75% of people with heart failure died in hospital between 2010 and 2015, although the majority preferred to die outside of hospital.

The current CMAJ study included 245 people in Ontario with chronic heart failure between 2013 and 2019 who participated in the collaborative care model and 1,172 who received usual care. The average age was 88 years and 55% were female.

The collaborative model involving primary care providers, cardiologists, and palliative care physicians was associated with fewer emergency room visits, fewer hospital and intensive care unit admissions toward the end of life, and a lower likelihood of dying in hospital (41%). v. 78%) than usual care. The model emphasized advance care planning; home treatment of heart failure; standardized protocols for clinical care; educating patients, families, and physicians; and collaboration between health professionals.

“The implementation and scalability of this model does not require major restructuring for providers,” says Dr. Kieran Quinn, palliative care physician at Sinai Health and the University of Toronto, Toronto, Ontario. “However, scalability requires increased awareness among all providers of the potential to provide integrated palliative and heart failure care.”

This model coincided with a regional cultural shift among palliative care physicians, cardiologists and other health care providers, as well as people with heart failure and their family caregivers. The model’s clinical leaders have worked tirelessly to deliver these changes in skills, behaviors and attitudes and champions are needed to expand to other regions.”

Dr. Sarina Isenberg, Bruyère Chair in Mixed Methods Palliative Care Research at the Bruyère Research Institute and the University of Ottawa

A related editorial https://www.cmaj.ca/lookup/doi/10.1503/cmaj.221332 Calls for widespread adoption of this model to help patients with a variety of illnesses living in the community, as well as people in long-term care facilities who could benefit from it.

“I hope that Quinn and his colleagues will widely publicize the details of their care pathways and training modules and that physicians and health care managers in regions across the country will recognize the benefits of providing high-quality, collaborative palliative care at home to patients.” serious heart disease (and other illnesses)," writes Dr. Andreas Laupacis, deputy editor, CMAJ. "It's time to make this happen."

He suggests changing funding models to include post-discharge care, with hospitals sharing funds with community partners who coordinate and deliver care.

The study was conducted by researchers at the Ottawa Hospital Research Institute, Bruyère Research Institute, University of Ottawa, Ottawa; University of Toronto, ICES and Sinai Health, Toronto, Ontario; Emory University, Atlanta, Georgia.

Source:

Journal of the Canadian Medical Association

Reference:

Quinn, K.L., et al. (2022) Regional Collaborative Home Palliative Care and Health Care Outcomes in Adults With Heart Failure. Journal of the Canadian Medical Association. doi.org/10.1503/cmaj.220784.