Abstract 13962: Goals of Care Intervention in Advanced Heart Failure

Abstract

Introduction: Guidelines for care in Stage D advanced heart failure (HF) include discussions of prognosis, advance care planning, and deactivation of the implantable defibrillator, along with symptom management and quality of life. The purpose of this study was to evaluate, among adults with advanced HF and their HF providers, the effect of a communication intervention designed to improve patient-provider communication about goals of care (GoC) that incorporated prognostic information from the Seattle HF Model (SHFM). Hypothesis: Patients in the GoC intervention will demonstrate increased numbers of GoC conversations, quality of communication, quality of life, with reduced depression and anxiety compared to usual care (UC). Methods: Eighty patients (40/group) with a diagnosis of HFrEF (EF%< 40%), mean age 58.2±11.2 years, 76.3% male, 82.5% Caucasian, EF%=30.3±9.7%, 1 year SHFM scores of 95.1% participated in a RCT comparing GoC to UC. HF providers were physicians and APRNs (N=9) in a tertiary care academic medical center. The GoC intervention: HF education, ICD deactivation information, and the Five Wishes directive, delivered in a nurse-led telephone discussion that preceded a subsequent HF clinic visit. At baseline and after the HF visit, the Quality of Communication (QOC), Kansas City Cardiomyopathy Questionnaire (KCCQ), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder (GAD-7) scales were completed. Numbers of GoC conversations are verified with medical records. Analysis of variance will be used to determine effects on study outcomes. Results: There was a significant increase in goals-of-care conversations (73% vs, 2.6%, p <0.001) and quality of end-of-life communication ( p =0.03) in the GoC group compared to UC after the intervention. There were no significant differences between groups on quality of life, anxiety, or depression. HF providers noted that having a GoC conversation within a regular HF clinic visit took additional clinic time. Conclusions: The GoC intervention resulted in more GoC conversations and higher quality communication between HF patients and HF providers without increased anxiety or depression. Further studies are needed to assess impact on longer-term quality of care and patient outcomes.