Spirituality in heart failure: a review of the literature from 2014 to 2019 to identify spiritual care needs and spiritual interventions.

PURPOSE OF REVIEW: The burden of heart failure is significant and its management is complex. Current evidence confirms a high level of spiritual distress and a strong desire for spiritual support, which is endorsed by healthcare policy, yet spiritual support is rarely provided for this patient group. There is a need to identify how spiritual support might be meaningfully included within holistic heart failure multidisciplinary care and how its effectiveness might be demonstrated. RECENT FINDINGS: A literature review was undertaken to identify recent evidence (2014-2019) of the spiritual care needs of heart failure patients/carers and the nature and effectiveness of spiritual interventions in heart failure care. SUMMARY: Taken as a whole, studies exploring heart failure patients'/carers' needs reflected the broad spectrum of spirituality as defined by international consensus, however, some studies focused on only some aspects of spirituality and on advanced disease. All studies were limited. No single spiritual intervention was identified as effective in enhancing quality of life in patients with heart failure. Life review and relaxation/meditation appeared ineffective. Interventions, which included elements of 'talking' about spiritual matters, 'spiritual coping' and those involving a holistic person-centred team approach to care of which spiritual care was an aspect, are worth investigating further in well designed randomized controlled trials.

The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial.

BACKGROUND: Cardiac rehabilitation improves health-related quality of life (HRQoL) and reduces hospitalizations in patients with heart failure, but international uptake of cardiac rehabilitation for heart failure remains low. DESIGN AND METHODS: The aim of this multicentre randomized trial was to compare the REACH-HF (Rehabilitation EnAblement in CHronicHeart Failure) intervention, a facilitated self-care and home-based cardiac rehabilitation programme to usual care for adults with heart failure with reduced ejection fraction (HFrEF). The study primary hypothesis was that the addition of the REACH-HF intervention to usual care would improve disease-specific HRQoL (Minnesota Living with Heart Failure questionnaire (MLHFQ)) at 12 months compared with usual care alone. RESULTS: The study recruited 216 participants, predominantly men (78%), with an average age of 70 years and mean left ventricular ejection fraction of 34%. Overall, 185 (86%) participants provided data for the primary outcome. At 12 months, there was a significant and clinically meaningful between-group difference in the MLHFQ score of -5.7 points (95% confidence interval -10.6 to -0.7) in favour of the REACH-HF intervention group ( p = 0.025). With the exception of patient self-care ( p < 0.001) there was no significant difference in other secondary outcomes, including clinical events ( p > 0.05) at follow-up compared with usual care. The mean cost of the REACH-HF intervention was £418 per participant. CONCLUSIONS: The novel REACH-HF home-based facilitated intervention for HFrEF was clinically superior in disease-specific HRQoL at 12 months and offers an affordable alternative to traditional centre-based programmes to address current low cardiac rehabilitation uptake rates for heart failure.