Background: Palliative care including symptom alleviation and advance care planning is relevant for patients with heart failure (HF). The Supportive and Palliative Care Indicator Tool (SPICT) is a tool for identifying patients who may benefit from palliative care assistance but is not validated in patients hospitalized for HF.
Methods and results: Clinical backgrounds, symptom burdens, and outcomes were evaluated using SPICT assessed on admission in consecutive hospitalized patients with HF. SPICT positive was defined as two or more general indicators and a New York Heart Association ≥III were present. Of 601 hospitalized patients with HF (mean age: 79±12 years, male: 314 [52%], and mean left ventricular ejection fraction: 44±18%), 100 (17%) patients were SPICT-positive. SPICT-positive patients were older (85±9 vs. 78±12 years; P<0.001) with higher clinical frailty scale (6±1 vs. 4±1 points; P<0.001), while symptom burdens assessed by the Integrated Palliative care Outcome Scale were not different (17 [13, 28] vs. 20 [11, 26] points; P=0.97) when compared with SPICT-negative. During the median follow-up period of 518 days, 178 patients (30%) died. SPICT positive was independently associated with higher all-cause mortality (hazard ratio: 3.49, 95% confidence interval: 2.41-5.05; P<0.001) after adjusting for age, sex, New York Heart Association class IV, Get-With-The-Guideline risk score, N-terminal pro B-type natriuretic peptide level, and left ventricular ejection fraction.
Conclusions: In patients admitted for HF, SPICT positive was significantly associated with higher all-cause mortality, suggesting the utility of SPICT as an indicator to initiate advance care planning for end-of-life care among hospitalized patients with HF.
Keywords: Heart failure; Palliative care; Supportive and Palliative Care Indicator Tool.
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