Early palliative care in heart failure shows neutral effects across EF subtypes: an exploratory EPCHF secondary analysis

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Balata M.; Khan A.; Hassan M.; Ebeid I.; Ortak J.; Ince H.; Becher M.U.

Journal: Clinical Research in Cardiology

Publisher: Springer Science and Business Media Deutschland GmbH

Publication Date: 16 December 2025

Volume / Issue: Volume 115 / Issue 9

Pages: 1603–1614

ISSN: 18610684

DOI: 10.1007/s00392-025-02828-9

Scopus: View on Scopus

PubMed: 41400671

Document Type: Article

Authors and Affiliations

Balata M., Department of Cardiology, University Hospital of Rostock, Ernst-Heydemann-Straße 6, Rostock, 18057, Germany; Khan A., Evangelisches Krankenhaus Paul Gerhardt Stift, Paul-Gerhardt-Straße 42, Lutherstadt Wittenberg, 06886, Germany; Hassan M., Department of Immunology, Theodor Bilharz Research Institute, Giza, Egypt; Ebeid I., National Institute of Diabetes and Endocrinology, El Sayeda Zeinab, 16 Al Kasr Al Aini, Cairo Governorate, 4260010, Egypt; Ortak J., Department of Cardiology, University Hospital of Rostock, Ernst-Heydemann-Straße 6, Rostock, 18057, Germany; Ince H., Department of Cardiology, University Hospital of Rostock, Ernst-Heydemann-Straße 6, Rostock, 18057, Germany; Becher M.U., University Hospital Bonn, Venusberg-Campus 1, Bonn, 53127, Germany, Department of Internal Medicine and Cardiology, City Hospital Solingen, Gotenstraße 1, Solingen, 42653, Germany

Abstract

Introduction: Early integration of palliative care (EIPC) has been proposed to improve quality of life in heart failure (HF), but evidence is mixed and potential differences by HF subtype remain unclear. This exploratory secondary analysis of the EPCHF trial examined whether patient-reported outcomes differed between patients with and without reduced EF. Methods: A total of 205 patients with symptomatic HF were randomized 1:1 to EIPC or standard care in the EPCHF trial. For this exploratory analysis, patients were stratified by left ventricular ejection fraction (≤ 40% vs > 40%). Patient-reported outcomes were assessed over 12 months using the Kansas City Cardiomyopathy Questionnaire (KCCQ), Functional Assessment of Chronic Illness Therapy–Palliative Care (FACIT-PAL), Hospital Anxiety and Depression Scale (HADS), MIDOS, and FACIT–SP12. Results: KCCQ scores, HADS-anxiety, and MIDOS symptom intensity improved significantly over 12 months in both EIPC and control groups, with no significant between-group differences in either EF subgroup. Reductions in HADS-depression occurred only in patients with HFrEF, with similar improvements 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). Among patients with LVEF > 40%, EIPC produced a significant improvement in spiritual well-being compared with standard care (mean difference 3.47; 95% CI: 0.32 to 6.62; p = 0.031), whereas the control group showed no improvement. Mortality and hospitalization rates did not differ between groups. Conclusion: In this exploratory EF-stratified analysis of EPCHF trial, EIPC did not improve overall HRQOL, mood, or symptom burden compared with standard care. A significant effect was observed only for spiritual well-being in patients with LVEF > 40%, suggesting that this subgroup may have distinct supportive-care needs warranting further investigation. © Springer-Verlag GmbH Germany, part of Springer Nature 2025.

Keywords

Health-related quality of life; Heart failure; Palliative care; Aged; Female; Humans; Male; Middle Aged; Patient Reported Outcome Measures; Quality of Life; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left; amino terminal pro brain natriuretic peptide; adult; Article; assessment of humans; controlled study; Edmonton Symptom Assessment System; follow up; Functional Assessment of Chronic Illness Therapy; heart failure with preserved ejection fraction; heart failure with reduced ejection fraction; heart left ventricle ejection fraction; Hospital Anxiety and Depression Scale; hospitalization; human; Kansas City Cardiomyopathy Questionnaire; Likert scale; medication compliance; Minimal Documentation System; mortality rate; New York Heart Association class; palliative therapy; patient-reported outcome; secondary analysis; spiritual well-being; symptom burden; clinical trial; diagnosis; heart left ventricle function; heart stroke volume; multicenter study; pathophysiology; physiology; procedures; randomized controlled trial; therapy; time factor

Citation Information

Scopus Citations: 0

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