Improving Care of Patients With Heart Failure

Heart failure (HF) affects more than 5 million Americans and is a major source of morbidity
and mortality. Despite optimal management, over half of patients with HF suffer from pain,
dyspnea, fatigue, and depression that diminish quality of life (QoL). HF care also exacts a
huge financial toll with yearly costs of $35 billion. Although consensus guidelines call
for providing palliative care (PC) to patients with HF to relieve suffering and improve QoL,
few receive it. The overall aim of this project is to conduct a randomized controlled trial
(RCT) to determine if an interdisciplinary PC intervention (Symptom Management Service-HF
[SMS-HF]) provided concurrently with standard cardiology care improves symptoms, QoL and
satisfaction, and reduces resource utilization in outpatients with Class II-IV HF compared
to standard cardiology care alone. Subjects assigned to the SMS-HF group will receive a
6-month interdisciplinary PC intervention based on the investigators successful SMS model of
outpatient PC for oncology patients and focused on assessment and management of physical,
emotional, social, and spiritual distress and discussion of treatment preferences.
Innovations of this study are that it will rigorously assess the impact of the SMS-HF on
patient outcomes and on resource utilization, a key component to ensuring program
sustainability. The investigators research team of PC and HF experts is recognized for its
PC research and has a proven record of collaborating, conducting RCTs of PC interventions,
and studying outpatients with HF. The environment at UCSF is highly supportive of
innovative research and of sustaining programs with demonstrated improvements in patient
outcomes and operational effectiveness. The overall goal is to use the results from this
study to support an application to the NIH for a multi-center RCT of the SMS-HF and to study
similar models of concurrent PC for patients with other serious illnesses.