WITHDRAWN: Advanced Heart Failure and Palliative Care: Opportunities for Social Work and Lessons from a Social Work Led Randomized Clinical Trial

Background and Purpose: Cardiovascular disease is the leading cause of death in the United States, killing over 800,000 people annually.  The prognosis for congestive heart failure (CHF) is poor, worse than many oncology diagnoses, with 38% of patients dying within one year and a 60% mortality rate at 5 years.  Yet most patients and families do not view heart failure as a terminal diagnosis.  Research reveals that the majority of heart failure patients greatly overestimate their prognosis, have not discussed their goals of care with their primary medical team and do not have advanced care planning documentation in their medical charts.  The field of palliative care, which focuses on patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering, has been integrated into oncology care.  However, cardiologists have been slow to incorporate palliative care principles into their practice.   Qualitative studies with cardiologists have revealed that they are reticent to start conversations with patients, citing ambiguity about when to start a conversation with a patient, lack of comfortability with issues around death and concern that if they bring up conversations about prognosis, patients will feel cardiologist are “giving up hope”. 

Using a recent clinical trial conducted at Brigham and Women’s Hospital which tested the model of embedding a palliative care trained social worker in a heart failure outpatient clinic, this poster will explore the integration of palliative care into medical care of patients with advanced heart failure.  It will focus on the integration of palliative care into medical care of patients with advanced heart failure, with an emphasis on the expertise, skill set and roles that social workers can offer in optimizing patients quality of life as these individuals are faced with the coping with the disease symptoms, defining their care goals, and building relationships with health care professionals.

Methods: This poster presents results from a randomized clinical trial of a social-work led communication intervention to increase patients’ understanding of the disease, promote physician-patient communication, and increase medical chart documentation of advanced care preferences.    The study population (n=50) had mean age 72+ years and had been hospitalized for heart failure management within 1 year. 

Results: At 6 months post-intervention, 65% of subjects in the intervention group compared with 33% of those in the usual-care control group had physician-level documentation of advanced care preferences in the electronic health record (p=0.02). Intervention patients were also more likely to revise their prognostic understanding of their illness in a direction consistent with the physician’s assessment (94% vs. 26%, p<0.001).  

Conclusions and implications: This successful pilot trial exploring a new model of embedded palliative care social workers on clinical teams for heart failure patients shows significant promise and may offer a cost-effective solution to increasing patients understanding and enhancing shared decision making in patients with heart failure.