Current evidence that supports palliative care interventions predominantly focuses on individuals with cancer or hospitalized patients. However, the effectiveness of palliative care on patient-reported outcomes and mortality in community-dwelling adults with heart failure has not been evaluated. We aimed to evaluate the effectiveness of palliative care interventions on patient-reported outcomes and all-cause mortality in community-dwelling adults with heart failure. A systematic review and meta-analysis of randomized controlled trials. MEDLINE, Embase, Cochrane Library, and CINAHL databases were searched from inception to October 2023. Randomized controlled trials were considered if they compared palliative care interventions with usual care, attention control, or waiting-list control primarily in a community-dwelling heart failure patient population. The primary outcome was patient-reported generic health-related or heart failure-specific quality of life. Secondary outcomes were patient-reported symptom burden, psychological health (anxiety and depression), spiritual well-being, and all-cause mortality. Two independent reviewers screened the retrieved articles and extracted data from the included studies. A random-effects meta-analysis was performed to pool the data, followed by sensitivity analysis, subgroup analysis, and meta-regression. All analyses were performed using R version 4.2.2. Eleven eligible studies were included in this review with a total of 1535 patients. Compared to usual care, palliative care interventions demonstrated statistically significant effects on improving generic health-related quality of life (SMD, 0.30 [95 % CI, 0.12 to 0.48]) and heart failure-specific quality of life (SMD, 0.17 [95 % CI, 0.03 to 0.31]). Palliative care interventions also reduced anxiety (SMD, −0.22 [95 % CI, −0.40 to −0.05]) and depression (SMD, −0.18 [95 % CI, −0.33 to −0.03]), and enhanced spiritual well-being (SMD, 0.43 [95 % CI, 0.05 to 0.81]), without adversely affecting all-cause mortality (RR, 1.00 [95 % CI, 0.76 to 1.33]). Yet, the interventions had no significant effects on symptom burden (SMD, −0.09 [95 % CI, −0.40 to 0.21]). The certainty of evidence across the outcomes ranged from very low to moderate based on the GRADE approach. Palliative care interventions are beneficial for community-dwelling adults with heart failure in that the interventions improved patient-reported quality of life, psychological health, and spiritual well-being, and importantly, did not lead to higher mortality rates. Findings of this review support the implementation of palliative care for adults with heart failure in community settings. CRD42023482495.

中文翻译：

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姑息治疗干预措施对社区居住的心力衰竭成人患者报告的结果和全因死亡率的有效性：系统评价和荟萃分析


目前支持姑息治疗干预措施的证据主要集中于癌症患者或住院患者。然而，姑息治疗对社区居住的心力衰竭成人患者报告的结果和死亡率的有效性尚未得到评估。我们的目的是评估姑息治疗干预措施对社区居住的心力衰竭成人的患者报告结果和全因死亡率的有效性。随机对照试验的系统回顾和荟萃分析。 MEDLINE、Embase、Cochrane Library 和 CINAHL 数据库的检索时间从开始到 2023 年 10 月。如果主要针对社区居住的心力衰竭患者将姑息治疗干预措施与常规护理、注意力控制或等候名单控制进行比较，则考虑进行随机对照试验人口。主要结局是患者报告的一般健康相关或心力衰竭特定的生活质量。次要结局是患者报告的症状负担、心理健康（焦虑和抑郁）、精神健康和全因死亡率。两名独立审稿人筛选检索到的文章并从纳入的研究中提取数据。进行随机效应荟萃分析来汇总数据，然后进行敏感性分析、亚组分析和荟萃回归。所有分析均使用 R 版本 4.2.2 进行。本次评价纳入了 11 项符合条件的研究，共有 1535 名患者。与常规护理相比，姑息治疗干预措施对改善一般健康相关生活质量（SMD，0.30 [95 % CI，0.12 至 0.48]）和心力衰竭特定生活质量（SMD，0.17 [95 %]）具有统计学显着效果。 CI，0.03 至 0.31]）。 姑息治疗干预措施还减少了焦虑（SMD，-0.22 [95 % CI，-0.40至-0.05]）和抑郁（SMD，-0.18 [95 % CI，-0.33至-0.03]），并增强了精神健康（ SMD，0.43 [95% CI，0.05 至 0.81]），不会对全因死亡率产生不利影响（RR，1.00 [95% CI，0.76 至 1.33]）。然而，干预措施对症状负担没有显着影响（SMD，-0.09 [95 % CI，-0.40 至 0.21]）。根据 GRADE 方法，结果的证据质量从非常低到中等不等。姑息治疗干预措施对社区居住的患有心力衰竭的成年人有益，因为这些干预措施改善了患者报告的生活质量、心理健康和精神健康，而且重要的是，不会导致更高的死亡率。本次审查的结果支持在社区环境中对患有心力衰竭的成人实施姑息治疗。 CRD42023482495。