Using Patient and Care Partner Perspectives to Optimize Rehabilitation in Advanced Heart Failure

Outcomes

1. Participants will be able to describe patient and care partner experiences of rehabilitation received after hospitalization for advanced heart failure. 2. Participants will be able to identify strategies to improve rehabilitation to address common issues faced by patients living with advanced heart failure and their care partners.

Key Message

Older adults living with advanced heart failure are frequently hospitalized and have a dual need for rehabilitation and palliative care. Our team is using patient and care partner perspectives on rehabilitation after hospitalization for advanced heart failure to develop a home-based palliative physical therapy intervention for this population.

Introduction

Older adults living with heart failure (HF) are frequently hospitalized1 and 47% are discharged to post-acute care for rehabilitation.2 Yet 24% of older adults hospitalized with HF die within 6 months of discharge2 and individuals in this population report substantial distress about functional decline and inability to perform self-care tasks in the last year of life.3,4

Objectives

To understand patient and care partner experiences with rehabilitation and use themes to guide the development of integrative palliative rehabilitation interventions to address the complex needs of older adults living with advanced HF and their care partners.

Methods

We enrolled academic medical center patients aged 65 years and older who were hospitalized with advanced HF (n=12) and care partners (n=10) to participate in this qualitative study. Participants completed separate, semi-structured qualitative interviews to discuss their experiences with rehabilitation in skilled nursing facilities and home-based care and ideas to improve rehabilitation moving forward. Three reviewers used the Framework method5 to develop a standardized, deductive coding scheme while inductively integrating new codes and themes as they emerged.

Results

To date, of 75 patients approached, 49 were interested and 12 completed interviews (75% male, 75% White); 26 care partners were interested and 10 completed interviews (60% female, 70% White). Half of patients reported multiple episodes of rehabilitation between hospitalizations—45% in skilled nursing facilities and 82% home-based care. Patients recommended improving alignment of patient and therapist expectations, collaborative goal setting, and having realistic conversations about potential for recovery. Care partners recommended longitudinal rehabilitation models to deter decline and maintain activity while navigating fluctuating symptoms and a need for increased psychosocial support.

Conclusion

We are using interview themes to develop a home-based physical therapy intervention supplemented with palliative care skills to enhance the lived experience of older adults with advanced HF and their care partners.

Keywords

Models of Palliative Care Delivery / Scientific Research