Primary palliative care for heart failure provided within ambulatory cardiology: A randomized pilot trial


      • This pilot randomized clinical trial demonstrates the feasibility, acceptability, and potential benefits of a novel intervention that integrates core palliative care principles into outpatient heart failure care.
      • Modifications to outpatient cardiology clinic processes, along with training in palliative care principles, can allow for cardiology teams to attend to palliative needs.



      Heart failure is characterized by physical and emotional symptoms and decreased quality of life (QoL). Palliative care can reduce burdens of serious illness but often is limited to inpatient or academic settings.


      To develop and test the Primary Education for Nurses in Palliative care-HF (PENPal-HF) intervention, training outpatient cardiology nurses to address symptom burden, patient priorities for care and QoL, and advance care planning as part of quarterly HF visits.


      We conducted a pilot randomized clinical trial for adults with NYHA Stage III or IV HF and ≥ 2 hospitalizations in the past 12 months, recruited from a community-based cardiology clinic. Participants were randomized 2:1, PENPal-HF plus usual care versus usual care alone. Primary outcomes were feasibility and acceptability.


      We randomized 30 adults with Stage III HF – 20 to PENPal-HF and 10 to usual care. Most in the intervention group (71%) and in the control group (62%) completed the study through the final outcome assessment in week 56; 5 participants died. Of 20 participants in the intervention, 14 (70%) remained in the study through the end of intervention visits; 11 (55%) completed all visits. Most intervention participants (93.75%) agreed or strongly agreed that they were satisfied with their care, and 87.5% agreed or strongly agreed that all people with HF should receive the intervention. Most intervention group participants (93.75%) reported a perceived improvement in physical symptoms, mood, and/or QoL.


      This pilot study suggests that nurse-led primary palliative care in outpatient cardiology settings is promising. Research is warranted to determine efficacy and effectiveness.

      Key words


      CASA (Collaborative Care to Alleviate Symptoms and Adjust to Illness), ENABLE-CHF (Educate Nurture Advise Before Life Ends), PENPal-HF (Primary Education for Nurses in Palliative care-HF), RE-AIM (reach effectiveness adoption implementation maintenance)
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