Palliative care in advanced heart failure: systematic review and meta-analysis

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.

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.

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.

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.

CRD42023489277.