Race Differences in Quality of Life following a Palliative Care Intervention in Patients with Advanced Heart Failure: Insights from the Palliative Care in Heart Failure Trial

Abstract

Introduction: Black patients have a higher incidence of heart failure (HF) and worse outcomes than white patients. Guidelines recommend palliative care for patients with advanced HF, but no studies have examined outcomes in a black patient cohort. Methods: This is a post hoc analysis of the Palliative Care in Heart Failure trial, which randomized patients to usual care plus a palliative care intervention (UC+PAL) or usual care (UC). Quality of life (QoL) was measured using Kansas City Cardiomyopathy Questionnaire (KCCQ) and Functional Assessment of Chronic Illness Therapy-Palliative Care scale (FACIT-Pal). Results: Black patients represented 41% of the 148 patients. At six months, QoL improved more in UC+PAL than UC for both racial subgroups. The difference was greater for black than white patients (difference: KCCQ 10.8 vs. 2.5; FACIT-Pal: 14.8 vs. 3.9). However, the findings were not statistically significant. Conclusions: Larger studies are needed to assess the benefits of palliative care for black patients with HF. ClinicalTrials.gov Identifier: NCT01589601.

Keywords: heart failure; palliative care; quality of life; race.

Conflict of interest statement

The authors report no relevant disclosures.

Figures

FIG. 1.

Six-month change in QoL measures by race and treatment group. (A) Mean baseline and six-month KCCQ and FACIT-Pal scores by race and treatment group. (B) Mean change in KCCQ and FACIT-Pal scores from baseline to six months by race and treatment group. (C) Mean difference in six-month change in KCCQ and FACIT-Pal scores between UC+PAL and UC treatment groups by race. FACIT-Pal, Functional Assessment of Chronic Illness Therapy-Palliative Care scale; KCCQ, Kansas City Cardiomyopathy Questionnaire; PAL, palliative care intervention; QoL, quality of life; UC, usual care.