A pilot study on the effect of advance care planning implementation on healthcare utilisation and satisfaction in patients with advanced heart failure

Abstract

Background Patients with advanced heart failure may benefit from palliative care, including advance care planning (ACP). ACP, which can include referral back to the general practitioner (GP), may prevent unbeneficial hospital admissions and interventional/surgical procedures that are not in accordance with the patient’s personal goals of care. Aim To implement ACP in patients with advanced heart failure and explore the effect of ACP on healthcare utilisation as well as the satisfaction of patients and cardiologists. Methods In this pilot study, we enrolled 30 patients with New York Heart Association class III/IV heart failure who had had at least one unplanned hospital admission in the previous year because of heart failure. A structured ACP conversation was held and documented by the treating physician. Primary outcome was the number of visits to the emergency department and/or admissions within 3 months after the ACP conversation. Secondary endpoints were the satisfaction of patients and cardiologists as established by using a five-point Likert scale. Results Median age of the patients was 81 years (range 33–94). Twenty-seven ACP documents could be analysed (90%). Twenty-one patients (78%) did not want to be readmitted to the hospital and subsequently none of them were readmitted during follow-up. Twenty-two patients (81%) discontinued all hospital care. All patients who died during follow-up (n = 12, 40%) died at home. Most patients and cardiologists indicated that they would recommend the intervention to others (80% and 92% respectively). Conclusion ACP, and subsequent out-of-hospital care by the GP, was shown to be applicable in the present study of patients with advanced heart failure and evident palliative care needs. Patients and cardiologists were satisfied with this intervention.

Advance Care Planning Affects End-of-Life Treatment Preferences Among Patients With Heart Failure

“…After the intervention, 21 patients (78%) indicated that they would not want to be readmitted and were thus not readmitted during the follow-up period, and 12 patients (40%) died at home during the follow-up period. 19 A South Korean study noted that the tendency to select hospice care was positively correlated with attitude toward ACP. 5 Therefore, ACP can affect EOL treatment decisions among patients with heart failure.…”

“…In a pilot study, an ACP intervention was conducted with 30 patients with New York Heart Association functional class III or IV heart failure who had experienced at least 1 unexpected hospitalization in the previous year. After the intervention, 21 patients (78%) indicated that they would not want to be readmitted and were thus not readmitted during the follow-up period, and 12 patients (40%) died at home during the follow-up period 19 . A South Korean study noted that the tendency to select hospice care was positively correlated with attitude toward ACP 5 .…”