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Heart and Vessels

, Volume 34, Issue 3, pp 452–461 | Cite as

Possible associations between palliative care conferences and positive outcomes when performing palliative care for patients with end-stage heart failure: a nationwide cross-sectional questionnaire survey

  • Yuma KurozumiEmail author
  • Shogo Oishi
  • Yasuo Sugano
  • Akihiro Sakashita
  • Norihiko Kotooka
  • Makoto Suzuki
  • Taiki Higo
  • Dai Yumino
  • Yasuko Takada
  • Seiko Maeda
  • Saori Yamabe
  • Koichi Washida
  • Tomonori Takahashi
  • Tomohito Ohtani
  • Yasushi Sakata
  • Yukihito Sato
Original Article
  • 109 Downloads

Abstract

Palliative care for end-stage heart failure should be provided by a multidisciplinary team. However, the influence of each occupational category on patients receiving palliative care for end-stage heart failure remains unclear. Thus, this study investigated the relationships between palliative care conferences and positive outcomes of palliative care for end-stage heart failure patients. We sent questionnaires to all cardiology training hospitals authorized by the Japanese Circulation Society (n = 1004); of these, responses from the directors at 554 institutions were analyzed. We divided the responding institutions into two groups according to their implementation of palliative care conferences for patients with end-stage heart failure. The institutions that had held such conferences (n = 223) had a larger number of hospital beds, beds in the cardiovascular department, and patients admitted to the cardiovascular department, compared with institutions that had not held these conferences (n = 321). The usage rates of opioids, non-steroidal anti-inflammatory drugs, and sedatives were significantly higher in institutions that held these conferences. Multivariate analysis revealed that nutritionists and medical social workers had greater involvement in the improvement of mental symptoms and ensuring that patients could stay where they wished, respectively. The presence of palliative care physicians, physical therapists, or pharmacists was associated with multiple positive outcomes. This study indicated that there are possible associations between palliative care conferences and positive outcomes when performing palliative care for patients with end-stage heart failure.

Keywords

Heart failure Palliative care Multidisciplinary team management Nationwide survey 

Notes

Acknowledgements

The authors would like to acknowledge the directors and staff of the 1004 cardiology training hospitals authorized by the Japanese Circulation Society for their cooperation with this survey. The authors thank Koji Shimamoto, MS (MediStatLab Co., Ltd., Tokyo, Japan, https://www.medistatlab.com/) for assistance with statistical methods.

Funding

This study received no grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

380_2018_1261_MOESM1_ESM.docx (15 kb)
Supplementary file1 (DOCX 14 kb)

References

  1. 1.
    Jessup M, Brozena S (2003) Heart failure. N Engl J Med 348:2007–2018CrossRefGoogle Scholar
  2. 2.
    Krum H, Teerlink JR (2011) Medical therapy for chronic heart failure. Lancet 378:713–721CrossRefGoogle Scholar
  3. 3.
    Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines (2013). 2013 ACCF/AHA guideline for the management of heart failure. Circulation 128:e240–e327Google Scholar
  4. 4.
    Levy M, Smith T, Alvarez-Perez A, Back A, Baker JN, Beck AC, Block S, Dalal S, Dans M, Fitch TR, Kapo J, Kutner JS, Kvale E, Misra S, Mitchell W, Portman DG, Sauer TM, Spiegel D, Sutton L, Szmuilowicz E, Taylor RM, Temel J, Tickoo R, Urba SG, Weinstein E, Zachariah F, Bergman MA, Scavone JL (2016) Palliative care version 1.2016. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 14:82–113CrossRefGoogle Scholar
  5. 5.
    Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, Firn JI, Paice JA, Peppercorn JM, Phillips T, Stovall EL, Zimmermann C, Smith TJ (2017) Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 35:96–112CrossRefGoogle Scholar
  6. 6.
    Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, Dale O, De Conno F, Fallon M, Hanna M, Haugen DF, Juhl G, King S, Klepstad P, Laugsand EA, Maltoni M, Mercadante S, Nabal M, Pigni A, Radbruch L, Reid C, Sjogren P, Stone PC, Tassinari D, Zeppetella G, European Palliative Care Research Collaborative (EPCRC); European Association for Palliative Care (EAPC) (2012). Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 13:e58–68CrossRefGoogle Scholar
  7. 7.
    Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742CrossRefGoogle Scholar
  8. 8.
    Nakazawa Y, Miyashita M, Morita T, Misawa T, Tsuneto S, Shima Y (2012) The current status and issues regarding hospital-based specialized palliative care service in Japanese regional cancer centers: A nationwide questionnaire survey. Jpn J Clin Oncol 42:432–441CrossRefGoogle Scholar
  9. 9.
    Sato Y (2015) Multidisciplinary management of heart failure just beginning in Japan. J Cardiol 66:181–188CrossRefGoogle Scholar
  10. 10.
    Nordgren L, Sörensen S (2003) Symptoms experienced in the last six months of life in patients with end-stage heart failure. Eur J Cardiovasc Nurs 2:213–217CrossRefGoogle Scholar
  11. 11.
    Riley JP, Beattie JM (2017) Palliative care in heart failure: facts and numbers. ESC Heart Fail 4:81–87CrossRefGoogle Scholar
  12. 12.
    Brännström M, Boman K (2014) Effects of person-centered and integrated chronic heart failure and palliative home care. PREFER: a randomized controlled study. Eur J Heart Fail 16:1142–1151CrossRefGoogle Scholar
  13. 13.
    Schwarz ER, Baraghoush A, Morrissey RP, Shah AB, Shinde AM, Phan A, Bharadwaj P (2012) Pilot study of palliative care consultation in patients with advanced heart failure referred for cardiac transplantation. J Palliat Med 15:12–15CrossRefGoogle Scholar
  14. 14.
    Lorenz KA, Lynn J, Dy SM, Shugarman LR, Wilkinson A, Mularski RA, Morton SC, Hughes RG, Hilton LK, Maglione M, Rhodes SL, Rolon C, Sun VC, Shekelle PG (2008) Evidence for improving palliative care at the end of life: a systematic review. Ann Intern Med 148:147–59CrossRefGoogle Scholar
  15. 15.
    Diop MS, Rudolph JL, Zimmerman KM, Richter MA, Skarf LM (2017) Palliative care interventions for patients with heart failure: a systematic review and meta-analysis. J Palliat Med 20:84–92CrossRefGoogle Scholar
  16. 16.
    Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force Members (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 37:2129–2200CrossRefGoogle Scholar
  17. 17.
    Kurozumi Y, Oishi S, Sugano Y, Sakashita A, Kotooka N, Suzuki M, Higo T, Yumino D, Takada Y, Maeda S, Yamabe S, Washida K, Takahashi T, Ohtani T, Sakata Y, Sato Y (2018) Design of a nationwide survey on palliative care for end-stage heart failure in Japan. J Cardiol 71:202–211CrossRefGoogle Scholar
  18. 18.
    Kuragaichi T, Kurozumi Y, Oishi S, Sugano Y, Sakashita A, Kotooka N, Suzuki M, Higo T, Yumino D, Takada Y, Maeda S, Yamabe S, Washida K, Takahashi T, Ohtani T, Sakata Y, Sato Y (2018) Nationwide survey of palliative care for patients with heart failure in Japan. Circ J 82:1336–1343CrossRefGoogle Scholar
  19. 19.
    World Health Organization. WHO Definition of Palliative Care. Available at http://www.who.int/cancer/palliative/definition/en/. Accessed April 8, 2018
  20. 20.
    Jaarsma T, Beattie JM, Ryder M, Rutten FH, McDonagh T, Mohacsi P, Murray SA, Grodzicki T, Bergh I, Metra M, Ekman I, Angermann C, Leventhal M, Pitsis A, Anker SD, Gavazzi A, Ponikowski P, Dickstein K, Delacretaz E, Blue L, Strasser F, McMurray J, Advanced Heart Failure Study Group of the HFA of the ESC (2009). Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 11:433–443CrossRefGoogle Scholar
  21. 21.
    Adler ED, Goldfinger JZ, Kalman J, Park ME, Meier DE (2009) Palliative care in the treatment of advanced heart failure. Circulation 120:2597–2606CrossRefGoogle Scholar
  22. 22.
    Goodlin SJ (2009) Palliative care in congestive heart failure. J Am Coll Cardiol 54:386–396CrossRefGoogle Scholar
  23. 23.
    McAlister FA, Stewart S, Ferrua S, McMurray JJ (2004) Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol 44:810–819Google Scholar
  24. 24.
    Fonarow GC, Albert NM, Curtis AB, Stough WG, Gheorghiade M, Heywood JT, McBride ML, Inge PJ, Mehra MR, O'Connor CM, Reynolds D, Walsh MN, Yancy CW (2010) Improving evidence-based care for heart failure in outpatient cardiology practices: primary results of the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF). Circulation 122:585–596CrossRefGoogle Scholar
  25. 25.
    Rogers JG, Patel CB, Mentz RJ, Granger BB, Steinhauser KE, Fiuzat M, Adams PA, Speck A, Johnson KS, Krishnamoorthy A, Yang H, Anstrom KJ, Dodson GC, Taylor DH Jr, Kirchner JL, Mark DB, O'Connor CM, Tulsky JA (2017) Palliative care in heart failure. J Am Coll Cardiol 70:331–341CrossRefGoogle Scholar
  26. 26.
    López-Sendín N, Alburquerque-Sendín F, Cleland JA, Fernández-de-las-Peñas C (2012) Effects of physical therapy on pain and mood in patients with terminal cancer: a pilot randomized clinical trial. J Altern Complement Med 18:480–486CrossRefGoogle Scholar
  27. 27.
    Lee JL, Leong LP, Lim SL (2016) Nutrition intervention approaches to reduce malnutrition in oncology patients: a systematic review. Support Care Cancer 24:469–480CrossRefGoogle Scholar
  28. 28.
    Viktil KK, Blix HS, Moger TA, Reikvam A (2006) Interview of patients by pharmacists contributes significantly to the identification of drug-related problems (DRPs). Pharmacoepidemiol Drug Saf 15:667–674CrossRefGoogle Scholar
  29. 29.
    McIlvennan CK, Allen LA (2016) Palliative care in patients with heart failure. BMJ 353:i1010CrossRefGoogle Scholar
  30. 30.
    Gelfman LP, Kavalieratos D, Teuteberg WG, Lala A, Goldstein NE (2017) Primary palliative care for heart failure: what is it? How do we implement it? Heart Fail Rev 22(5):611–620CrossRefGoogle Scholar
  31. 31.
    Johnson MJ, McDonagh TA, Harkness A, McKay SE, Johnson Dargie HJ, MJ1, McDonagh TA, Harkness A, McKay SE, Dargie HJ, (2002) Morphine for the relief of breathlessness in patients with chronic heart failure—a pilot study. Eur J Heart Fail 4:753–756CrossRefGoogle Scholar
  32. 32.
    Williams SG, Wright DJ, Marshall P, Reese A, Tzeng BH, Coats AJ, Tan LB (2003) Safety and potential benefits of low dose diamorphine during exercise in patients with chronic heart failure. Heart 89:1085–1086CrossRefGoogle Scholar
  33. 33.
    Chua TP, Harrington D, Ponikowski P, Webb-Peploe K, Poole-Wilson PA, Coats AJ (1997) Effects of dihydrocodeine on chemosensitivity and exercise tolerance in patients with chronic heart failure. J Am Coll Cardiol 29:147–152CrossRefGoogle Scholar
  34. 34.
    Oxberry SG, Torgerson DJ, Bland JM, Clark AL, Cleland JG, Johnson MJ (2011) Short-term opioids for breathlessness in stable chronic heart failure: a randomized controlled trial. Eur J Heart Fail 13:1006–1012CrossRefGoogle Scholar
  35. 35.
    Burns J, Jackson K, Sheehy KA, Finkel JC, Quezado ZM (2017) the use of dexmedetomidine in pediatric palliative care: a preliminary study. J Palliat Med 20(7):779–783CrossRefGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Yuma Kurozumi
    • 1
    Email author
  • Shogo Oishi
    • 2
  • Yasuo Sugano
    • 3
    • 4
  • Akihiro Sakashita
    • 5
  • Norihiko Kotooka
    • 6
  • Makoto Suzuki
    • 7
  • Taiki Higo
    • 8
  • Dai Yumino
    • 9
  • Yasuko Takada
    • 10
  • Seiko Maeda
    • 11
  • Saori Yamabe
    • 12
  • Koichi Washida
    • 13
  • Tomonori Takahashi
    • 14
  • Tomohito Ohtani
    • 15
  • Yasushi Sakata
    • 15
  • Yukihito Sato
    • 1
  1. 1.Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
  2. 2.Department of CardiologyHimeji Cardiovascular CenterHimejiJapan
  3. 3.Department of CardiologyKeiyu HospitalYokohamaJapan
  4. 4.Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
  5. 5.Department of Palliative MedicineKobe University School of MedicineKobeJapan
  6. 6.Department of Cardiovascular MedicineSaga UniversitySagaJapan
  7. 7.Department of CardiologyYokohama Minami Kyosai HospitalYokohamaJapan
  8. 8.Department of Cardiovascular MedicineKyushu University Graduate School of Medical SciencesFukuokaJapan
  9. 9.Yumino Heart ClinicTokyoJapan
  10. 10.Department of NursingNational Cerebral and Cardiovascular CenterSuitaJapan
  11. 11.Department of NursingNagoya Heart CenterNagoyaJapan
  12. 12.Department of NursingMitsubishi Kyoto HospitalKyotoJapan
  13. 13.Department of NursingHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
  14. 14.Department of PharmacyHyogo Cancer CenterAkashiJapan
  15. 15.Department of Cardiovascular MedicineOsaka University Graduate School of MedicineSuitaJapan

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