Abstract
Context
Although palliative care is guideline-indicated for patients with advanced heart failure
(HF), the scarcity of a specialty-trained palliative care workforce demands better
identification of patients who are most burdened by the disease
Objectives
We sought to identify latent subgroups with variations regarding symptom burden, functional
status, and multimorbidity in an advanced HF population.
Methods
We performed a latent class analysis (LCA) of baseline data from a trial enrolling
advanced HF patients. As LCA input variables, we chose indicators of HF severity,
physical and psychological symptom burden, functional status, and the number of comorbidities.
Results
Among 563 patients, two subgroups emerged from LCA, Class A (352 [62.5%]) and Class
B (211 [37.5%]). Patients in Class A were less often classified as NYHA class III
or IV (88.0% vs. 97.5%, P < 0.001), as compared to Class B patients. Class A patients had fewer symptoms, fewer
comorbidities, only 25.9% had impairments in activities of daily living (ADL), and
virtually none suffered from clinically significant anxiety (0.4%) or depression (0.9%).
In Class B, every patient reported more than three symptoms, almost all patients (92.6%)
had some impairment in ADL, and nearly a third had anxiety (30.2%) or depression (28.3%).
All-cause mortality after 12 months was higher in Class B, as compared to Class A
(18.5% vs. 12.5%, P = 0.047).
Conclusion
Among advanced HF patients, we identified a distinct subgroup characterized by a conjunction
of high symptom burden, anxiety, depression, multimorbidity, and functional status
impairment, which might profit particularly from palliative care interventions.
Graphical Abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: October 27, 2022
Accepted:
October 19,
2022
Identification
Copyright
© 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
