Systematic Review and Meta-Analysis Finds Palliative Care Improves Quality of Life in Advanced Heart Failure
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Key Takeaway
Consider integrating palliative care for advanced heart failure to improve quality of life and reduce readmissions, though mortality benefit remains unproven.
This systematic review and meta-analysis evaluated the effects of palliative care in patients with advanced heart failure, including 2165 patients across multiple studies. The primary scope was to synthesize evidence on patient-centered outcomes such as quality of life, psychological well-being, cardiac function, and healthcare utilization.
Key findings showed that palliative care significantly improved quality of life (SMD=1.12, 95% CI 0.28 to 1.97, p=0.009), alleviated anxiety (SMD=-1.27, 95% CI -1.89 to -0.65, p<0.0001) and depression (SMD=-1.33, 95% CI -1.95 to -0.71, p<0.0001), and improved cardiac function (MD=4.41, 95% CI 2.73 to 6.09, p<0.00001). Readmission rates were reduced (RR=0.70, 95% CI 0.52 to 0.94, p=0.02), but mortality was not significantly reduced (RR=1.29, 95% CI 0.82 to 2.05, p=0.28).
The authors noted that the certainty of evidence across outcomes ranged from low to moderate based on the GRADE approach, and called for more high-quality, large-sample studies. Adverse events were not reported. The review provides evidence-based support for further research and a foundation for implementing clinical palliative care in this population.
Clinicians should interpret these findings cautiously given the low-to-moderate certainty, but the consistent benefits across multiple outcomes suggest palliative care may be a valuable component of advanced heart failure management.
View Original Abstract ↓
AIM: This study aims to systematically evaluate the effects of palliative care on the quality of life, anxiety level, depression level, cardiac function, readmission rate and mortality rate among patients with advanced heart failure, in order to provide evidence-based support for further research in this area.
METHODS: Randomised controlled trials of palliative care for patients with advanced heart failure were retrieved from CNKI, WANFANG DATA, CQVIP, SinoMed, CINAHL, Medline, PubMed, Web of Science and Embase, and references were traced. The search deadline was set as 17 July 2025. Two researchers independently screened literature, extracted data and evaluated the quality of included literature according to the Cochrane Handbook V.5.1.0. Meta-analysis was conducted using RevMan 5.3.
RESULTS: A total of 20 references were included, involving 2165 patients with advanced heart failure. The results of the meta-analysis showed that palliative care can improve the quality of life (standardised mean difference (SMD)=1.12, 95% CI 0.28 to 1.97, p=0.009), alleviate anxiety (SMD=-1.27, 95% CI -1.89 to -0.65, P<0.0001) and depression (SMD=-1.33, 95% CI -1.95 to -0.71, p<0.0001)), improve cardiac function (MD=4.41, 95% CI 2.73 to 6.09, p<0.00001) and reduce readmission rates (relative risk (RR)=0.70, 95% CI 0.52 to 0.94, p=0.02), but did not show a significant reduction in mortality rate (RR=1.29, 95% CI 0.82 to 2.05, p=0.28). The certainty of evidence across the outcomes ranged from low to moderate based on the GRADE approach.
CONCLUSION: Palliative care can enhance the quality of life, alleviate anxiety and depression, improve heart function and reduce readmission rates for patients with advanced heart failure. However, it does not reduce the mortality rate. This article can provide a foundation for the widespread implementation of clinical palliative care. More high-quality and large-sample studies are needed in the future to further explore the impact of palliative care on patients with advanced heart failure.
PROSPERO REGISTRATION NUMBER: CRD42023489277.
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