Primary palliative care for heart failure provided within ambulatory cardiology: A randomized pilot trial.

The trial was done at one community cardiology clinic with one nurse, so it may not reflect other clinics or staffing models. It randomized only 30 patients and did not compare outcomes between the intervention and usual care groups. Attrition was high: 40% in the intervention group and 50% in the control group. Mortality was 17% of randomized participants, which may affect how well the intervention could be completed. Most participants were white (83%), so the findings may not apply to all patient groups. Qualitative interviews included only 4 intervention participants, one nurse, and one cardiologist. The study paid for the nurse's time and resources, which may not be available in usual clinical practice.

The work was supported by the National Heart Lung and Blood Institute. Authors declared funding grants from the Cystic Fibrosis Foundation, American Heart Association, National Institutes of Health, and Patient-Centered Outcomes Research Institute. Larry Allen reported consulting or advisory work for Boston Scientific Corp.

Do not read 93.75% satisfaction or 87.5% agreement that all patients should receive the intervention as proof that the program improves heart failure outcomes. The study did not test differences between intervention and usual care, and the authors say pilot results should not be used to drive clinical care decisions until powered trials show efficacy.