Trial Outcomes & Findings for ENABLE CHF-PC (Comprehensive Heartcare For Patients and Caregivers) (NCT NCT02505425)

NCT ID: NCT02505425

Last Updated: 2022-01-18

Results Overview

Baseline patient-reported Quality of Life (QOL) was measured on the Kansas City Cardiomyopathy Questionnaire (KCCQ) Clinical Summary Score, a heart failure-specific 23-item instrument. The KCCQ consists of 4 clinical domains: symptoms - frequency \& severity; Physical Limitation; Quality of Life and Social Limitation and captures the patient's perspective of heart failure. Clinical summary scores range from 0 to 100. Higher KCCQ scores indicate better perceived health status. KCCQ clinical summary scores greater than or equal to 50 indicate good QOL.

• Recruitment status: COMPLETED
• Study phase: NA
• Target enrollment: 573 participants
• Primary outcome timeframe: Baseline
• Results posted on: 2022-01-18

Participant Flow

The study recruitment period was from October 2015 thru October 2018. Recruitment occurred at two sites: the University of Alabama at Birmingham (UAB) and the Birmingham Veterans Affairs Medical Center (BVAMC).

Participant milestones

Measure	Active Intervention for Patients Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Overall Study STARTED	208	207	82	76
Overall Study COMPLETED	120	125	32	50
Overall Study NOT COMPLETED	88	82	50	26

Reasons for withdrawal

Measure	Active Intervention for Patients Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Overall Study Lost to Follow-up	41	61	31	19
Overall Study Withdrawal by Subject	39	9	19	7
Overall Study Death	8	12	0	0

Baseline Characteristics

ENABLE CHF-PC (Comprehensive Heartcare For Patients and Caregivers)

Baseline characteristics by cohort

Measure	Active Intervention for Patients n=208 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=207 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=82 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=76 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Total n=573 Participants Total of all reporting groups
Sex: Female, Male Female	97 Participants n=5 Participants	97 Participants n=7 Participants	73 Participants n=5 Participants	62 Participants n=4 Participants	329 Participants n=21 Participants
Age, Continuous	63.5 Years STANDARD_DEVIATION 8.0 • n=5 Participants	64.1 Years STANDARD_DEVIATION 9.1 • n=7 Participants	58.2 Years STANDARD_DEVIATION 12.4 • n=5 Participants	57.6 Years STANDARD_DEVIATION 10.8 • n=4 Participants	60.85 Years STANDARD_DEVIATION 10.1 • n=21 Participants
Sex: Female, Male Male	111 Participants n=5 Participants	110 Participants n=7 Participants	9 Participants n=5 Participants	14 Participants n=4 Participants	244 Participants n=21 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants
Race (NIH/OMB) Asian	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants
Race (NIH/OMB) Black or African American	113 Participants n=5 Participants	113 Participants n=7 Participants	46 Participants n=5 Participants	36 Participants n=4 Participants	308 Participants n=21 Participants
Race (NIH/OMB) White	92 Participants n=5 Participants	92 Participants n=7 Participants	32 Participants n=5 Participants	38 Participants n=4 Participants	254 Participants n=21 Participants
Race (NIH/OMB) More than one race	3 Participants n=5 Participants	2 Participants n=7 Participants	3 Participants n=5 Participants	2 Participants n=4 Participants	10 Participants n=21 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants n=5 Participants	0 Participants n=7 Participants	1 Participants n=5 Participants	0 Participants n=4 Participants	1 Participants n=21 Participants
Region of Enrollment United States	208 Participants n=5 Participants	207 Participants n=7 Participants	82 Participants n=5 Participants	76 Participants n=4 Participants	573 Participants n=21 Participants

PRIMARY outcome

Timeframe: Baseline

Population: This measure pertains to Patient Quality of Life (QOL). Caregiver QOL was analyzed using a different measure.

Baseline patient-reported Quality of Life (QOL) was measured on the Kansas City Cardiomyopathy Questionnaire (KCCQ) Clinical Summary Score, a heart failure-specific 23-item instrument. The KCCQ consists of 4 clinical domains: symptoms - frequency & severity; Physical Limitation; Quality of Life and Social Limitation and captures the patient's perspective of heart failure. Clinical summary scores range from 0 to 100. Higher KCCQ scores indicate better perceived health status. KCCQ clinical summary scores greater than or equal to 50 indicate good QOL.

Outcome measures

Measure	Active Intervention for Patients n=208 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=207 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Quality of Life as Measured on the Kansas City Cardiomyopathy Questionnaire (KCCQ) Clinical Summary Score	54.2 score on a scale Standard Deviation 20.5	51.1 score on a scale Standard Deviation 21.5	—	—

PRIMARY outcome

Timeframe: 16 weeks

Population: This measure pertains to Patient Quality of Life (QOL) using the KCCQ. Caregiver QOL was analyzed using a different measure.

Patient-reported Quality of Life (QOL) was measured on the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 16 weeks. The KCCQ consists of 4 clinical domains: symptoms - frequency & severity; Physical Limitation; Quality of Life and Social Limitation and captures the patient's perspective of heart failure. Clinical summary scores range from 0 to 100. Higher KCCQ scores indicate better perceived health status. KCCQ clinical summary scores greater than or equal to 50 indicate good QOL.

Outcome measures

Measure	Active Intervention for Patients n=120 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=125 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Quality of Life as Measured on the Kansas City Cardiomyopathy Questionnaire (KCCQ) Clinical Summary Score	59.7 score on a scale Standard Error 1.8	54.8 score on a scale Standard Error 1.8	—	—

PRIMARY outcome

Timeframe: Baseline

Population: This measure pertains to Patient Quality of Life (QOL). Caregiver QOL was analyzed using a different measure.

Baseline patient-reported Quality of Life (QOL) was measured on the Functional Assessment of Chronic Illness Therapy-Palliative Care Scale (FACIT-PAL-14). Scores range from 0 to 56; higher scores indicate better quality of life.

Outcome measures

Measure	Active Intervention for Patients n=208 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=207 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Quality of Life as Measured on the Functional Assessment of Chronic Illness Therapy-Palliative Care Scale (FACIT-PAL-14)	36.8 score on a scale Standard Deviation 9.3	36.1 score on a scale Standard Deviation 9.7	—	—

PRIMARY outcome

Timeframe: 16 weeks

Population: This measure pertains to Patient Quality of Life (QOL). Caregiver QOL was analyzed using a different measure. One intervention participant and two usual care participants did not provide sufficient responses to contribute to this outcomes measure score at 16 weeks.

Patient-reported Quality of Life (QOL) was measured on the Functional Assessment of Chronic Illness Therapy-Palliative Care Scale (FACIT-PAL-14) at 16 weeks. Scores range from 0 to 56; higher scores indicate better quality of life.

Outcome measures

Measure	Active Intervention for Patients n=119 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=123 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Quality of Life as Measured on the Functional Assessment of Chronic Illness Therapy-Palliative Care Scale (FACIT-PAL-14)	38.5 score on a scale Standard Error 0.8	36.8 score on a scale Standard Error 0.8	—	—

PRIMARY outcome

Timeframe: Baseline

Population: This measure pertains to Patient \& Caregiver Mood - Anxiety HADS

Baseline patient & caregiver-reported mood - Anxiety - was measured on the Hospital Anxiety and Depression Scale (HADS). 7 items measure anxiety symptoms.Scores range from 0 to 21; higher scores indicate more severe symptoms.

Outcome measures

Measure	Active Intervention for Patients n=208 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=207 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=82 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=76 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient & Caregiver Mood - Anxiety - as Measured on the Hospital Anxiety and Depression Scale (HADS)	6.6 score on a scale Standard Deviation 3.5	6.8 score on a scale Standard Deviation 3.7	3.9 score on a scale Standard Deviation 3.1	3.7 score on a scale Standard Deviation 2.9

PRIMARY outcome

Timeframe: 16 weeks

Population: This measure pertains to Patient \& Caregiver Mood - Anxiety HADS. One intervention patient and three usual care patients did not provide sufficient responses to contribute to this outcomes measure score at 16 weeks.

Change from baseline in patient & caregiver-reported mood - Anxiety was measured on the HADS. 7 items measure anxiety symptoms. Scores range from 0 to 21; higher scores indicate more severe symptoms.

Outcome measures

Measure	Active Intervention for Patients n=119 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=122 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=32 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=50 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient & Caregiver Mood - Anxiety - as Measured on the Hospital Anxiety and Depression Scale (HADS)	6.6 score on a scale Standard Error 0.3	7.1 score on a scale Standard Error 0.3	3.8 score on a scale Standard Error 0.5	4.2 score on a scale Standard Error 0.4

PRIMARY outcome

Timeframe: Baseline

Population: This measure pertains to Patient and Caregiver Mood - Depression Scale.

Baseline patient and caregiver-reported depression was measured on the Hospital Anxiety and Depression Scale (HADS). 7 items measure depression symptoms. Scores range from 0 to 21; higher scores indicate more severe symptoms.

Outcome measures

Measure	Active Intervention for Patients n=208 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=207 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=82 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=76 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient & Caregiver Mood - Depression - as Measured on the Hospital Anxiety and Depression Scale (HADS)	5.7 score on a scale Standard Deviation 4.3	5.8 score on a scale Standard Deviation 4.2	4.7 score on a scale Standard Deviation 3.1	4.8 score on a scale Standard Deviation 3.3

PRIMARY outcome

Timeframe: 16 weeks

Population: This measure pertains to Patient and Caregiver Mood - Depression Scale. One intervention patient and three usual care patients did not provide sufficient responses to contribute to this outcomes measure score at 16 weeks.

Patient and caregiver-reported depression was measured on the Hospital Anxiety and Depression Scale (HADS) at 16 weeks. 7 items measure depression symptoms. Scores range from 0 to 21; higher scores indicate more severe symptoms.

Outcome measures

Measure	Active Intervention for Patients n=119 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=122 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=32 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=50 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient & Caregiver Mood - Depression - as Measured on the Hospital Anxiety and Depression Scale (HADS)	4.9 score on a scale Standard Error 0.3	5.6 score on a scale Standard Error 0.3	4.5 score on a scale Standard Error 0.5	4.4 score on a scale Standard Error 0.4

PRIMARY outcome

Timeframe: Baseline

Population: This measure was conducted among Caregiver participants only.

Baseline caregiver-reported quality of life (QOL) was measured on the Bakas Caregiving Outcomes Scale (BCOS). Score range: 15-105; higher scores indicate higher quality of life.

Outcome measures

Measure	Active Intervention for Patients Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=82 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=76 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Caregiver Quality of Life as Measured on the Bakas Caregiving Outcomes Scale (BCOS)	—	—	65.0 score on a scale Standard Deviation 12.9	60.7 score on a scale Standard Deviation 10.4

PRIMARY outcome

Timeframe: 16 weeks

Population: This measure conducted among Caregiver participants only.

Caregiver-reported quality of life (QOL) was measured on the Bakas Caregiving Outcomes Scale (BCOS) at 16 weeks. Score range: 15-105; higher scores indicate higher quality of life.

Outcome measures

Measure	Active Intervention for Patients Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=32 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=50 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Caregiver Quality of Life as Measured on the Bakas Caregiving Outcomes Scale (BCOS)	—	—	66.9 score on a scale Standard Error 2.1	63.9 score on a scale Standard Error 1.7

PRIMARY outcome

Timeframe: Baseline

Population: Montgomery Borgatta Caregiver Burden Scale (MBCB) was measured among Caregivers only.

Baseline caregiver-reported Objective burden was measured on the Montgomery Borgatta Caregiver Burden Scale (MBCB). This subscale measures the object burden, interference with the caregiver's day-to-day activities given caregiving demands. Score range: 6-30, Greater than 23 indicates high burden.

Outcome measures

Measure	Active Intervention for Patients Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=82 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=76 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Caregiver Burden - Objective - as Measured on the Montgomery Borgatta Caregiver Burden Scale (MBCB)	—	—	20.1 score on a scale Standard Error 2.8	20.0 score on a scale Standard Error 2.9

PRIMARY outcome

Timeframe: 16 weeks

Population: Montgomery Borgatta Caregiver Burden Scale (MBCB) was measured among Caregivers only.

Caregiver-reported Objective burden was measured on the Montgomery Borgatta Caregiver Burden Scale (MBCB) at 16 weeks. This subscale measures the object burden, interference with the caregiver's day-to-day activities given caregiving demands.Score range: 6-30, Greater than 23 indicates high burden.

Outcome measures

Measure	Active Intervention for Patients Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=32 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=50 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Caregiver Burden - Objective - as Measured on the Montgomery Borgatta Caregiver Burden Scale (MBCB)	—	—	20.2 score on a scale Standard Error 0.5	19.7 score on a scale Standard Error 0.4

PRIMARY outcome

Timeframe: Baseline

Population: Montgomery Borgatta Caregiver Burden Scale (MBCB) was measured among Caregivers only.

Baseline caregiver-reported Demand burden was measured on the Montgomery Borgatta Caregiver Burden Scale (MBCB). This subscale measures the demand burden or the strain among caregivers from meeting the needs of the care recipient. Score range: 6-30, Greater than 23 indicates high burden.

Outcome measures

Measure	Active Intervention for Patients Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=82 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=76 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Caregiver Burden - Demand - as Measured on the Montgomery Borgatta Caregiver Burden Scale (MBCB)	—	—	11.6 score on a scale Standard Deviation 2.5	11.6 score on a scale Standard Deviation 1.8

PRIMARY outcome

Timeframe: 16 weeks

Population: Montgomery Borgatta Caregiver Burden Scale (MBCB) was measured among Caregivers only.

Caregiver-reported Demand burden was measured on the Montgomery Borgatta Caregiver Burden Scale (MBCB) at 16 weeks. This subscale measures the demand burden or the strain among caregivers from meeting the needs of the care recipient. Score range: 6-30, Greater than 23 indicates high burden.

Outcome measures

Measure	Active Intervention for Patients Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=32 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=50 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Caregiver Burden - Demand - as Measured on the Montgomery Borgatta Caregiver Burden Scale (MBCB)	—	—	11.1 score on a scale Standard Error 0.4	11.6 score on a scale Standard Error 0.3

PRIMARY outcome

Timeframe: Baseline

Population: Montgomery Borgatta Caregiver Burden Scale (MBCB) was conducted among Caregivers only.

Baseline caregiver-reported Stress burden was measured on the Montgomery Borgatta Caregiver Burden Scale (MBCB). his subscale indicates the stress burden or emotional stress from the demands of caregiving. Score range: 6-30, Greater than 23 indicates high burden.

Outcome measures

Measure	Active Intervention for Patients Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=82 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=76 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Caregiver Burden - Stress - as Measured on the Montgomery Borgatta Caregiver Burden Scale (MBCB)	—	—	12.3 score on a scale Standard Deviation 2.4	12.3 score on a scale Standard Deviation 2.2

PRIMARY outcome

Timeframe: 16 weeks

Population: Montgomery Borgatta Caregiver Burden Scale (MBCB) was measured among Caregivers only.

Caregiver-reported Stress burden was measured on the Montgomery Borgatta Caregiver Burden Scale (MBCB) at 16 weeks. This subscale indicates the stress burden or emotional stress from the demands of caregiving. Score range: 6-30, Greater than 23 indicates high burden.

Outcome measures

Measure	Active Intervention for Patients Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=32 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=50 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Caregiver Burden - Stress- as Measured on the Montgomery Borgatta Caregiver Burden Scale (MBCB)	—	—	11.7 score on a scale Standard Error 0.4	12.2 score on a scale Standard Error 0.3

SECONDARY outcome

Timeframe: Baseline

Baseline patient- and caregiver-reported PHYSICAL health status was measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form Global Health-10. The PROMIS SF Global Health-10 measures general domains of health including physical, mental, and social health, symptoms, overall quality of life. Summed scores for PROMIS measures are converted to T scores with a mean of 50 and standard deviation of 10 in the general US population; higher scores indicate better functioning.

Outcome measures

Measure	Active Intervention for Patients n=208 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=207 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=82 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=76 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient and Caregiver PHYSICAL Health Status as Measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form Global Health-10	38.6 score on a scale Standard Deviation 8.0	38.1 score on a scale Standard Deviation 8.0	46.9 score on a scale Standard Deviation 8.9	48.0 score on a scale Standard Deviation 8.6

SECONDARY outcome

Timeframe: 16 weeks

Population: One intervention and three usual care patients did not provide sufficient responses to contribute to this outcomes measure score at 16 weeks. One intervention patient and three usual care patients did not provide sufficient responses to contribute to this outcomes measure score at 16 weeks.

Patient- and caregiver-reported PHYSICAL health status was measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form Global Health at 16 weeks. The PROMIS SF Global Health-10 measures general domains of health including physical, mental, and social health, symptoms, overall quality of life. Summed scores for PROMIS measures are converted to T scores with a mean of 50 and standard deviation of 10 in the general US population; higher scores indicate better functioning.

Outcome measures

Measure	Active Intervention for Patients n=119 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=122 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=32 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=50 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient and Caregiver PHYSICAL Health Status as Measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form Global Health-10	39.4 score on a scale Standard Error 0.7	38.8 score on a scale Standard Error 0.7	46.9 score on a scale Standard Error 8.9	48.0 score on a scale Standard Error 8.6

SECONDARY outcome

Timeframe: Baseline

Baseline patient- and caregiver-reported MENTAL health status was measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form Global Health. The PROMIS SF Global Health-10 measures general domains of health including physical, mental, and social health, symptoms, overall quality of life. Summed scores for PROMIS measures are converted to T scores with a mean of 50 and standard deviation of 10 in the general US population; higher scores indicate better functioning.

Outcome measures

Measure	Active Intervention for Patients n=208 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=207 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=82 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=76 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient and Caregiver MENTAL Health Status as Measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form Global Health-10	45.8 score on a scale Standard Deviation 8.6	44.9 score on a scale Standard Deviation 8.7	48.5 score on a scale Standard Deviation 7.1	48.1 score on a scale Standard Deviation 7.9

SECONDARY outcome

Timeframe: 16 weeks

Population: One intervention patient and three usual care patients did not provide sufficient responses to contribute to this outcomes measure score at 16 weeks.

Patient- and caregiver-reported MENTAL health status was measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form Global Health at 16 weeks. The PROMIS SF Global Health-10 measures general domains of health including physical, mental, and social health, symptoms, overall quality of life. Summed scores for PROMIS measures are converted to T scores with a mean of 50 and standard deviation of 10 in the general US population; higher scores indicate better functioning.

Outcome measures

Measure	Active Intervention for Patients n=119 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=122 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers n=32 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers n=50 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient and Caregiver MENTAL Health Status as Measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form Global Health-10	45.9 score on a scale Standard Error 0.7	44.7 score on a scale Standard Error 0.7	47.7 score on a scale Standard Error 1.0	48.2 score on a scale Standard Error 0.9

SECONDARY outcome

Timeframe: Baseline

Population: This outcomes measure pertains to patient-reported symptom burden.

Baseline patient-reported symptom burden was measured on symptom-based items from the Kansas City Cardiomyopathy Questionnaire (KCCQ). Higher KCCQ scores indicate better perceived health status. The KCCQ Symptom burden domain consists of 8 items and quantifies the frequency, severity and change over time with clinical symptoms in heart failure, including fatigue, shortness of breath, paroxysmal nocturnal dyspnea and patients' edema/swelling. KCCQ symptom domain scores range from 0 to 100; A score of 50 is the threshold between unstable heart failure symptoms (<50) or stable heart failure symptoms (>=50).

Outcome measures

Measure	Active Intervention for Patients n=208 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=207 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Symptom Burden as Measured on the Kansas City Cardiomyopathy Questionnaire (KCCQ) Symptom Items	52.2 score on a scale Standard Deviation 22.1	50.9 score on a scale Standard Deviation 24.2	—	—

SECONDARY outcome

Timeframe: 16 weeks

Population: This outcomes measure pertains to patient-reported symptom burden.

Patient-reported symptom burden was measured on symptom-based items from the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 16 weeks. Higher KCCQ scores indicate better perceived health status. The KCCQ Symptom burden domain consists of 8 items and quantifies the frequency, severity and change over time for clinical symptoms in heart failure, including fatigue, shortness of breath, paroxysmal nocturnal dyspnea and patients' edema/swelling. KCCQ symptom domain scores range from 0 to 100; A score of 50 is the threshold between unstable heart failure symptoms (<50) or stable heart failure symptoms (>=50).

Outcome measures

Measure	Active Intervention for Patients n=120 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=125 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Symptom Burden Items as Measured on the Kansas City Cardiomyopathy Questionnaire (KCCQ) Symptom Items.	59.6 score on a scale Standard Error 2.0	55.3 score on a scale Standard Error 1.9	—	—

SECONDARY outcome

Timeframe: Baseline

Population: Measure conducted among patients only.

Baseline patient-reported PAIN INTENSITY was measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Scale. Higher pain scores indicate more pain. Score range: 0-100; Scores greater than 50 indicate high pain.

Outcome measures

Measure	Active Intervention for Patients n=208 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=207 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Pain Intensity as Measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) 3-item Pain Intensity Scale	46.8 score on a scale Standard Deviation 10.8	45.1 score on a scale Standard Deviation 10.5	—	—

SECONDARY outcome

Timeframe: 16 weeks

Population: Measure conducted among patients only. One intervention participant and three usual care participants did not provide sufficient responses to contribute to this outcomes measure score at 16 weeks.

Patient-reported PAIN INTENSITY was measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Scale at 16 weeks. Higher pain scores indicate more pain. Score range: 0-100; Scores greater than 50 indicate high pain.

Outcome measures

Measure	Active Intervention for Patients n=119 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=122 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Pain Intensity as Measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) 3-item Pain Intensity Scale	45.8 score on a scale Standard Error 0.9	47.4 score on a scale Standard Error 0.9	—	—

SECONDARY outcome

Timeframe: Baseline

Population: This measure was conducted among patients only.

Baseline patient-reported PAIN INTERFERENCE was measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Scale. Higher pain interference scores indicate more interference in daily life. Score range: 0-100; Scores greater than 50 indicate high pain.

Outcome measures

Measure	Active Intervention for Patients n=208 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=207 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Pain Interference as Measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) 2-item Pain Interference Scale	55.4 score on a scale Standard Deviation 10.9	54.5 score on a scale Standard Deviation 10.7	—	—

SECONDARY outcome

Timeframe: 16 weeks

Population: Conducted among patients only. One intervention participant and three usual care participants did not provide sufficient responses to contribute to this outcomes measure score at 16 weeks.

Patient-reported PAIN INTERFERENCE was measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Scale at 16 weeks. Higher pain interference scores indicate more interference in daily life. Score range: 0-100; Scores greater than 50 indicate high pain.

Outcome measures

Measure	Active Intervention for Patients n=119 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=122 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Pain Interference as Measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) 2-item Pain Interference Scale	54.3 score on a scale Standard Error 0.9	57.7 score on a scale Standard Error 0.9	—	—

SECONDARY outcome

Timeframe: Baseline

Population: Patient resource use (e.g. hospital admissions and days, emergency visits) was only captured among patients.

Baseline patient-reported health care utilization - Number of Days in Hospital, last two months - was measured on the Resource Use Questionnaire. This measure is an investigator-developed instrument to capture number of Inpatient days, ICU days, ED visits, hospice use, palliative care provider visits, AD completion, and DNR orders. The possible range of Days in Hospital is 0 Days to 60 Days (last/previous two months prior to this measure).

Outcome measures

Measure	Active Intervention for Patients n=208 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=206 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Resource Use - Days in Hospital - as Measured on the Investigator-developed Instrument	2.59 days Interval 1.64 to 4.07	2.75 days Interval 1.74 to 4.34	—	—

SECONDARY outcome

Timeframe: 16 weeks

Population: Patient resource use (e.g. hospital admissions and days, emergency visits) was only captured among patients. One intervention participant and one usual care participant did not provide sufficient responses to contribute to this outcomes measure at 16 weeks.

Patient-reported health care utilization - Number of Days in Hospital, last two months - was measured on the Resource Use Questionnaire at 16 weeks. This measure is an investigator-developed instrument to capture number of Inpatient days, ICU days, ED visits, hospice use, palliative care provider visits, AD completion, and DNR orders. The possible range of Days in Hospital is 0 Days to 60 Days (last/previous two months prior to this measure).

Outcome measures

Measure	Active Intervention for Patients n=119 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=124 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Resource Use - Days in Hospital - as Measured on the Investigator-developed Instrument	1.51 days Interval 0.82 to 2.77	1.29 days Interval 0.71 to 2.38	—	—

SECONDARY outcome

Timeframe: Baseline

Population: Patient resource use (e.g. hospital admissions and days, emergency visits) was only captured among patients. One participant in the Usual Care group did not respond to this survey item.

Baseline patient-reported health care utilization - Number of Emergency Department Visits, last two months - was measured on the Resource Use Questionnaire. This measure is an investigator-developed instrument to capture number of Inpatient days, ICU days, ED visits, hospice use, palliative care provider visits, AD completion, and DNR orders. The possible range of Visits to ED is 0 Visits to 60 Visits (in the last/previous two months prior to this measure).

Outcome measures

Measure	Active Intervention for Patients n=208 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=206 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Resource Use - Emergency Department Visits - as Measured on the Investigator-developed Instrument	0.3 visits Interval 0.23 to 0.4	0.28 visits Interval 0.21 to 0.37	—	—

SECONDARY outcome

Timeframe: 16 weeks

Population: Patient resource use (e.g. hospital admissions and days, emergency visits) was only captured among patients. One intervention participant did not provide sufficient responses to contribute to this outcomes measure score at 16 weeks.

Patient-reported health care utilization - Number of Emergency Department Visits, last two months - was measured on the Resource Use Questionnaire at 16 weeks. This measure is an investigator-developed instrument to capture number of Inpatient days, ICU days, ED visits, hospice use, palliative care provider visits, AD completion, and DNR orders. The possible range of Visits to ED is 0 Visits to 60 Visits (in the last/previous two months prior to this measure).

Outcome measures

Measure	Active Intervention for Patients n=119 Participants Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Patients n=125 Participants Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Active Intervention for Caregivers Behavioral: behavioral support Usual HF Care + ENABLE CHF-PC Behavioral Support: ENABLE CHF-PC includes: 1. In-person comprehensive Palliative Care Team (PCT) Consultation- as soon as feasible after enrollment. 2. Palliative Care Nurse Coach (PNC) embedded within HF teams, instituting a phone-based 6-session patient and a 4-session caregiver curriculum followed by monthly phone-based supportive care for 48 weeks or patient death. The PNC uses the manualized curriculum: "Charting Your Course (CYC): An Intervention for Patients with Heart Failure and their Families". Usual Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.	Usual HF Care for Caregivers Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines. Usual HF Care: Usual heart failure care includes any available supportive care resources and heart failure patient medical management based on national HF guidelines.
Patient Resource Use - Emergency Department Visits - as Measured on the Investigator-developed Instrument	0.17 visits Interval 0.11 to 1.26	0.19 visits Interval 0.13 to 0.28	—	—

Adverse Events

Active Intervention for Patients

Serious events: 0 serious events

Other events: 0 other events

Deaths: 8 deaths

Usual HF Care for Patients

Serious events: 0 serious events

Other events: 0 other events

Deaths: 12 deaths

Active Intervention for Caregivers

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Usual HF Care for Caregivers

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Marie A. Bakitas, DNSc, NP-C, FAAN

The University of Alabama at Birmingham, School of Nursing

Phone: (205) 934-5277

Email: mbakitas@uab.edu

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place