Spirituality can improve quality of life for heart failure patients

Numerous studies have shown that spirituality can help improve quality of life for people with chronic diseases like cancer. According to a literature review published today in JACC Heart Failure, spirituality can also have a positive impact on quality of life for heart failure patients. It further concludes spirituality should be considered a potential target for palliative care interventions to improve patient-centered and clinical outcomes in these individuals.

"Patients who have heart failure experience a poorer quality of life compared to their peers, with high levels of depression, anxiety and spiritual distress," said Rachel S. Tobin, MD, resident in Internal Medicine at Duke University Hospital, and lead author of the study. "Contributing to diminished quality of life is the fact that heart failure, unlike many other chronic diseases, is very unpredictable and can lead to hopelessness, isolation and altered self-image."

The American College of Cardiology and other major cardiovascular societies recommend palliative care for heart failure patients.

Spirituality is a core domain of palliative care, with the goal of identifying and addressing spiritual concerns and providing patients with appropriate spiritual and religious resources. However, limited research has been conducted on spirituality's impact on patients with heart failure, and there are no known tools designed to measure it.

According to the researchers, spirituality is hard to define, but they reference several definitions that describe spirituality as how individuals find meaning and purpose in life, which can be separate from religious beliefs.

For instance, the Institute of Medicine defines spirituality as "the needs and expectations which humans have to find meaning, purpose and value in their life. Such needs can be specifically religious, but even people who have no religious faith or are not members of an organized religion have belief systems that give their lives meaning and purpose."

Researchers conducted a review of 47 articles in order to explore the current knowledge of spirituality in heart failure patients; describe associations between spirituality and quality of life, as well as patient outcomes; and propose clinical applications and future directions for spirituality in this population. There were approximately 10 varying instruments used to measure spirituality, some simple, others complex. Key data examined include:

• In the Palliative Care in Heart Failure (PAL-HF) trial, spiritual well-being improved in patients randomized to a palliative care intervention compared to usual care as evaluated by FACIT-Sp. The FICA spiritual history tool was also used to gather information on spirituality.

• Patients randomized to palliative care had increased quality of life as measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) and Functional Assessment of Chronic Illness Therapy-Palliative Care (FACIT-Pal). They were also found to have lower levels of anxiety and depression.

• Another study found that after a 12-week mail-based psychosocial intervention, patients completing the intervention had higher quality of life as measured by KCCQ, as well as less depression and searching for meaning. Out of the 33 patients included, 85.7% felt that the intervention was worthwhile. In a pilot study, spiritual counseling was associated with improved quality of life, although there was no control group to determine if the effect was significant.

"The literature suggests not only can spirituality improve quality of life for the patient, it can help support caregivers and potentially help heart failure patients from needing to be readmitted to the hospital," Tobin said. "What we have suggested and are now doing is developing a spirituality screening tool, similar to ones used to screen for depression. This can be used to identify heart failure patients in palliative care who are at risk for spiritual distress. However, this is just a start. More research needs to be done."

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