Patients with heart failure and those with advanced malignancies are
similarly burdened by symptoms, depression, and quality-of-life
issues that can be addressed by care providers, with the need
significantly greater among the most debilitated patients with heart
failure, according to a small observational study [1].

"Most of what's done in palliative care these days is directed
toward people with cancer," Dr David Bekelman (University of
Colorado at Denver Health Sciences Center, Aurora) observed for
heartwire. "Perhaps we can do more to reduce the burden of heart
failure on patients. We're really good at pain management, but it's
important to know that the patients suffer in a variety of ways that
doctors can potentially help with."

At a session here today at the American Heart Association 2008
Quality of Care and Outcomes Research in Cardiovascular Disease and
Stroke Conference, Bekelman presented his group's analysis of 60
outpatients with NYHA class 2-4 heart failure and 30 with advanced,
unresectable nonˇVsmall-cell lung cancer or pancreatic
adenocarcinoma. They found that questionnaire scores for symptom
severity, depression, and "spiritual well-being" were similar for
both groups of patients. Worst off was the subgroup of heart-failure
patients with the poorest clinical status, as defined by a score <50
on the Kansas City Cardiomyopathy Questionnaire (KCCQ).

Perhaps heart-failure patients tend to get less palliative care than
cancer patients in part because there is often less certainty about
their prognosis, according to Bekelman. "Heart failure has a much
different illness trajectory. There are a lot of ups and downs. [The
patients] can die at any time from sudden cardiac death, or they can
enter the hospital critically ill and then sometimes they recover,"
he said. "That's a major illness-related barrier to providing
palliative care."

Although there's been little study of ways to identify which heart-
failure patients are most in need of such care, the KCCG might be
helpful, the study suggests. Clinicians can be vigilant for symptoms
of depression and could, as needed, steer patients toward
antidepressant therapy or counseling, Bekelman proposed. "Maybe
asking patients how the condition is affecting them in their life
and relationships can get at some of the spiritual issues."

Bekelman D, Rumsfeld J, Havranek E, et al. Symptom burden,
depression, and spiritual well-being: A comparison of heart failure
and advanced cancer patients. Quality of Care and Outcomes Research
in Cardiovascular Disease and Stroke Conference 2008; May 2, 2008;
Baltimore, MD. Abstract 171.