Palliative care in pulmonary hypertension: A systematic review and meta-analysis

Abstract

BACKGROUND

Pulmonary arterial hypertension (PAH) is a debilitating and progressive pulmonary pathology that often leads to death. Guidelines recommend the use of palliative care (PC) early in the treatment course to ease the burden of symptoms; however, uptake remains low.

AIM

To evaluate barriers to PC uptake and determine its association with mortality in patients with PAH.

METHODS

All studies discussing PC in PAH were selected in our review and analysis. Clinical and cross-sectional studies were included. Barriers were described in a qualitative fashion. A random-effects meta-analysis was also conducted, in which the odds ratio for mortality was pooled and reported, along with 95% confidence intervals.

RESULTS

A total of 19 studies were included in the review. The most common barriers identified included feeling like the patients were “not sick enough”, belief that PC is only appropriate for end-of-life care, belief that it would burden family members, and general feelings of hopelessness. Physicians identified structural causes, such as a lack of funding and low levels of PC-related knowledge, as barriers to recommending PC. The meta-analysis showed no statistically significant difference in mortality across four included studies (Log odds ratio = 0.89, 95% confidence intervals: -3.06-1.28). Heterogeneity was high (I² = 80.32%).

CONCLUSION

Uptake of PC in PAH is low due to patient and physician-level barriers, which can be overcome with systematic PC integration. Long-term studies are also needed to investigate the impact of PC on outcomes in PAH, as the current limited data show no significant difference.

Keywords: Palliative care; Pulmonary arterial hypertension; Barriers; Underutilization; Outcomes

Core Tip: There are significant patient and physician-level barriers hindering the uptake of palliative care in pulmonary arterial hypertension, including feelings of hopelessness, depression, sadness, lack of funding, and lack of knowledge. These psychological and systemic challenges collectively limit timely referral and integration of palliative services within routine pulmonary arterial hypertension management. A meta-analysis of four studies reveals no statistically significant difference in mortality with palliative care (Log odds ratio = 0.89, 95% confidence intervals: -3.06-1.28).