Comprehensive Palliative Care Needs in Outpatients with Chronic Heart Failure: A Japanese Cross-Sectional Study

Background: The type and frequency of palliative care needs of chronic heart failure (CHF) patients have not been determined in Japan.

Objectives: The aim of this study was to comprehensively assess the prevalence and characteristics of palliative care needs of CHF outpatients.

Methods: Patients were recruited for this cross-sectional study from June 1 to August 31, 2020, at the Kobe University Hospital. An Integrated Palliative care Outcome Scale (IPOS) and an original questionnaire developed by multidisciplinary experts were answered once by patients themselves or with the assistance of their family.

Results: A total of 101 patients (63 males and 38 females) were included. The most common distressing symptoms were dyspnea (29%; 95% confidence interval [CI] 21-39]), drowsiness (29%; 95% CI 21-39), poor mobility (25%; 95% CI 17-35), insomnia (25%; 95% CI 17-35), and anxiety (24%; 95% CI 17-35). Eighty percent (95% CI 70-87) of patients were willing to have an end-of-life (EOL) discussion. When we compared New York Heart Association class I/II with III/IV patients, the frequency of distressing symptoms was associated with the severity of the disease, but both groups exhibited a willingness for having an EOL discussion or knowing the future course of their diseases.

Conclusions: Dyspnea, drowsiness, insomnia, and anxiety were frequent symptoms in CHF outpatients in Japan. Beyond distressing symptoms, most ambulatory heart failure patients have a need for EOL discussion, which was not associated with disease stage. Assessing comprehensive and multidimensional palliative care needs, including needs for EOL discussion, is advisable among outpatients with CHF.