Examining Adherence and Dose Effect of an Early Palliative Care Intervention for Advanced Heart Failure Patients.

Abstract Context Research priority guidelines highlight the need for examining the “dose” components of palliative care (PC) interventions, such as intervention adherence and completion rates, that contribute to optimal outcomes. Objectives Examine the “dose” effect of PC intervention completion vs. non-completion on quality of life (QoL) and healthcare use in patients with advanced heart failure (HF) over 32 weeks. Methods Secondary analysis of the ENABLE CHF-PC intervention trial for patients with New York Heart Association (NYHA) Class III/IV HF. ‘Completers’ defined as completing a single, in-person outpatient palliative care consultation (OPCC) plus six weekly, PC nurse coach-led telehealth sessions. ‘Non-completers’ were defined as either not attending the OPCC or completing Results Of 208 intervention group participants, 81 (38.9%) were classified as ‘completers’ with a mean age of 64.6 years; 72.8% were urban-dwelling; 92.5% had NYHA Class III HF. ‘Completers’ vs. ‘non-completers’ groups were well-balanced at baseline; however ‘non-completers’ did report higher anxiety (6.0 vs 7.0, p Conclusion Higher intervention completion rates of an early PC intervention was associated with QoL improvements in patients with advanced HF. Future work should focus on identifying the most efficacious “dose” of intervention components and increasing adherence to them. Trial Registration ClinicalTrials.gov Identifier: NCT02505425 Key Message Higher intervention completion of a HF early PC intervention (ENABLE CHF-PC) was associated with QoL improvements in patients with advanced HF. Future work should seek to enhance adherence to early PC interventions and identify other efficacious intervention “dose” components.