Early palliative care in heart failure shows neutral effects across EF subtypes: an exploratory EPCHF secondary analysis.
Mahmoud Balata, Asim Khan, Marwa Hassan et al.
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In 30 seconds
This exploratory secondary analysis of the multicentre randomised EPCHF trial assessed whether early integrated palliative care (EIPC) affected patient-reported outcomes differently by ejection-fraction subgroup in 205 patients with symptomatic heart failure. Over 12 months, quality-of-life, anxiety and symptom-intensity measures improved in both EIPC and standard-care groups, without significant between-group differences in either subgroup. Among patients with LVEF > 40%, EIPC was associated with better spiritual well-being than standard care (mean difference 3.47; 95% CI: 0.32 to 6.62; p = 0.031). Mortality and hospitalisation rates did not differ.
Key findings
- KCCQ, HADS-anxiety and MIDOS measures improved over 12 months, with no significant EIPC–control differences in either EF subgroup.
- In HFrEF, HADS-depression decreased in both EIPC (-1.37; 95% CI: -2.31 to -0.44; p = 0.004) and control (-1.99; 95% CI: -2.89 to -1.09; p < 0.001).
- For LVEF > 40%, spiritual well-being improved with EIPC versus standard care (mean difference 3.47; 95% CI: 0.32 to 6.62; p = 0.031).
- Mortality and hospitalisation rates did not differ between groups.
Why it matters
The analysis suggests that broad patient-reported benefits of early palliative care were not evident over standard care across EF subgroups, despite improvements over time in both groups. The isolated spiritual well-being result in patients with LVEF > 40% may point to differing supportive-care needs, but requires confirmation before being interpreted as a subgroup-specific benefit.
What to keep in mind
This was an exploratory secondary analysis, and the reported subgroup finding should be interpreted cautiously.