Highlights
- •The vast majority of patients hospitalized with acute decompensated heart failure say they have never discussed their wishes for end-of-life care with their doctor.
- •End-of-life discussions were not more common with patients with worse prognosis.
- •Patients who recall having discussions were more knowledgeable about end-of-life options and more likely to have completed an advance directive.
Abstract
Background
Although guidelines call on clinicians to conduct regular conversations about advance
care planning and end-of-life (EOL) preferences with patients with heart failure (HF),
research suggests that physicians often avoid these discussions.
Methods and Results
From January 20, 2014, to January 18, 2016, Southeastern Minnesota residents hospitalized
with acute decompensated HF (ADHF) at Mayo Clinic hospitals were enrolled into an
observational cohort study that included the administration of face-to-face questionnaires.
Risk of death (prognosis) was estimated using the Meta-analysis Global Group in Chronic
Heart Failure score. Among 400 patients (mean age 77.7 years, 46% female, 48% preserved
ejection fraction), only 69 (17%) reported previously discussing EOL wishes with their
physician. Patients reporting EOL discussions more often had an advance directive
(81% vs 66%; P = .009), recognized the term “hospice” (96% vs 87%; P = .027), and had more favorable attitudes of dying and hospice (P = .030). Resuscitation preferences and rates of completion of advance directives
varied with prognosis, although patient-clinician EOL discussions did not.
Conclusions
The majority of patients hospitalized with ADHF did not recall discussing their preferences
for EOL care with their physician. This represents an important modifiable gap in
the optimal longitudinal care of HF patients.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiac FailureAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Executive summary: heart disease and stroke statistics—2016 update: a report from the American Heart Association.Circulation. 2016; 133: 447-454
- Executive summary: HFSA 2010 comprehensive heart failure practice guideline.J Card Fail. 2010; 16: 475-539
- 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.Circulation. 2013; 128: e240-e327
- Advance directives among hospitalized patients with heart failure.JACC Heart Fail. 2015; 3: 112-121
- Advance directives in community patients with heart failure.Circ Cardiovasc Qual Outcomes. 2012; 5: 283-289
- A survey of clinician attitudes and self-reported practices regarding end-of-life care in heart failure.Palliat Med. 2015; 29: 260-267
- Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies.Eur Heart J. 2013; 34: 1404-1413
- Resuscitation preferences among patients with severe congestive heart failure: results from the SUPPORT project. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.Circulation. 1998; 98: 648-655
- Choices of seriously ill patients about cardiopulmonary resuscitation: correlates and outcomes. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.Am J Med. 1996; 100: 128-137
- Self-rated health predicts healthcare utilization in heart failure.J Am Heart Assoc. 2014; 3: e000931
- Brief questions to identify patients with inadequate health literacy.Fam Med. 2004; 36: 588-594
- Psychometric characteristics of a quality of communication questionnaire assessing communication about end-of-life care.J Palliat Med. 2006; 9: 1086-1098
- Development and testing of a short form of the patient activation measure.Health Serv Res. 2005; 40: 1918-1930
- Perceptions and attitudes about hospice and palliative care among community-dwelling older adults.Am J Hosp Palliat Care. 2013; 30: 153-161
- Health literacy and outcomes among patients with heart failure.JAMA. 2011; 305: 1695-1701
- Predicting survival in heart failure: validation of the MAGGIC heart failure risk score in 51,043 patients from the Swedish heart failure registry.Eur J Heart Fail. 2014; 16: 173-179
- Decision making in advanced heart failure: a scientific statement from the American Heart Association.Circulation. 2012; 125: 1928-1952
- Accuracy of physician prognosis in heart failure and lung cancer: comparison between physician estimates and model predicted survival.Palliat Med. 2016; 30: 684-689
Article info
Publication history
Published online: August 22, 2017
Accepted:
August 16,
2017
Received in revised form:
August 9,
2017
Received:
March 10,
2017
Footnotes
Funding: National Institutes of Health (K23 HL 116643, primary investigator Dunlay).
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
