Validation of a Supportive and Palliative Care Indicator Tool among hospitalized patients with heart failure

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.