Vol. 43 No. 2 February 2012 345Schedule With Abstracts

Background. Heart failure (HF) is a commonchronic medical condition worldwide that im-pacts quality of life (QoL).

Research objectives. To identify predictors ofheart-related QoL and change over time amongpatients with HF.

Method. We conducted a prospective cohortstudy to survey outpatients with HF receivingstandard cardiology care at baseline and at 3-6month follow-up. We assessed QoL with the Min-nesota Living with HF Questionnaire (MLHFQ),pain (Brief Pain Inventory) and depression(CES-D).

Result. Participants (N ¼ 104) were on average53 years old and had NYHA HF Class II (57%)or III (43%). The mean score on the MLHFQ(range: 0[better]-105[worse])was 49.5 (Class II¼36.7, Class III ¼ 66.0). While HF Class, comor-bidities, depression, pain, and dyspnea were as-sociated with QoL (p # 0.05), multivariatelinear regression analysis identified variablesmaking the strongest contribution other thanHF Class (13.8%), were dyspnea (4.5%) and de-pression (13.7%). At follow-up, subjects (n ¼ 73)with Class III had improved QoL (mean ¼ 67.9-59.6; n ¼ 34, p ¼ 0.01), but not those with ClassII (mean ¼ 37.7-35.8; n ¼ 39, p ¼ 0.41). Nearlyhalf of patients 47.9% (n ¼ 35) had a clinicallymeaningful improvement (5-points). After ad-justing for HF Class, depression, and pain inter-ference, logistic regression analysis revealed thatonly HF Class was associated with improvementin QoL (Class III: OR ¼ 4.1, 95% CI ¼ 1.2,13.3).

Conclusion. Depression and dyspnea are associ-ated with diminished QoL independent of HFClass. While patients with Class III HF had poor-er QoL at baseline, they were more likely to im-prove over time receiving standard care.

Implications for research, policy, or practice. Byaddressing depression and other symptoms,palliative care consultations, provided concur-rently with standard care may lead to greaterimprovements in QoL for patients with HF.

Prognostic Tools for Congestive HeartFailure (315-B)Veeravat Taecharvongphairoj, MD, VA GreaterLos Angeles, Los Angeles, CA. Jaime Goldberg,LCSW, VA Greater Los Angeles, Los Angeles,

CA. Anne Walling, MD PhD, VA Greater LosAngeles Healthcare System, Los Angeles, CA.Kenneth Rosenfeld, MD, VA Greater Los An-geles, Los Angeles, CA. Karl Lorenz, MD, VAGreater Los Angeles, Los Angeles, CA.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Recognize the importance of prognostica-

tion in palliative care and describe chal-lenges of prognostications.

2. Review results of systematic review for prog-nostic tools for congestive heart failure.

Background. Congestive heart failure (CHF) isa major cause of death in the U.S. Accurateprognostication is important to frame care plan-ning in palliative care consultation but is oftena challenging task, especially for non-malignantlife-limiting illness.

Aim. We performed a systematic review to iden-tify clinically useful prognostic tools for conges-tive heart failure (CHF) published betweenJanuary 1, 1990 through December 31, 2010.

Methods/Session descriptions. Broad search cri-teria were used and two physicians indepen-dently reviewed titles, abstracts, and full articlesusing explicit criteria. Areas of disagreementfor inclusion were discussed until agreementreached at each level of analysis. References ofarticles included in our final review were also re-viewed in detail to ensure completeness. Finalarticles were evaluated based on their study de-sign, study population, scoring, limitations, andthe availability of variables needed to calculatethe prognostic score.1,597 publications were identified with oursearch criteria, and after structured review, ulti-mately 37 publications were found to report onclinically useful prognostic tools, and 32 distinctprognostic tools were identified. Only one toolwas specifically designed to determine hospiceeligibility. While the majority of these toolshave only been validated in small sample sizes,we identified 9 tools (7 inpatient, 2 outpatient)that have been validated in large populations(N > 1000) and have been validated in at leasttwo studies.

Conclusion. Statistically validated prognostictools are available for CHF and may be used toenhance prognostication during palliative careconsultation.