Advance Directives and Factors Associated with the Completion in Patients with Heart Failure.

Jinshil Kim,Shinmi Kim,Mi-Seung Shin,Albert Youngwoo Jang,Eunseok Cha,Minjeong An,Seongkum Heo

doi:10.3390/ijerph18041780

Abstract

Advance directive (AD) has been underutilized among patients with heart failure (HF). This study was performed to explore the ADs and examine factors associated with the completion of an AD survey in patients with HF. In a descriptive, correlational study, data on end-of-life values, treatment directives, and proxy (Korean-Advance Directive (K-AD) questionnaire) and factors associated with K-AD completion were collected among HF patients during outpatient visits. Of 67 patients (age, 67 years; male, 61.2%), 52.2% completed all or part of the K-AD. Among values, comfortable death was the most preferred (n = 15) followed by avoiding family burden (n = 6). In those completers, preferences for hospice care, cardiopulmonary resuscitation, ventilation support, and hemodialysis were 68.6%, 42.9%, 28.6%, and 28.6%, respectively. Female sex (odds ratio (OR) = 0.167), poorer HF prognosis (OR = 0.156), and better functional status (OR = 0.905) were associated with less likelihood of completing the AD survey. The findings suggest that in-depth AD discussion needs to be started earlier in patients with HF to facilitate completion of AD, especially in female patients. Future research should investigate if early discussion of ADs as part of advance care planning with integration into standard care of HF facilitates the documentation of ADs.

Highlights

Heart failure (HF) is considered a global pandemic health concern in Western andAsian countries today [1,2,3]
The purpose of this study was to explore EoL values, treatment preference, and proxy of patients with HF using a Korean Advance Directive (K-advance directive (AD)) questionnaire and examine factors associated with the completion of the K-AD survey
Somewhat different results of proxy appointments were reported by patients with cancer, with spouses being appointed as a proxy most frequently (70.5%), followed by adult children (20.4%) [28]. These findings suggest that family members [11], spouses and children who were primarily designated as a proxy regardless of illnesses, are encouraged to participate in an in-depth discussion regarding ADs to understand and be informed of patients’ EoL values

Summary

Introduction

Heart failure (HF) is considered a global pandemic health concern in Western and. Asian countries today [1,2,3]. Patients with HF live longer due to therapeutic advances [4,5], but experience high rates of cardiac or non-cardiac morbidity and mortality during the progressive debilitating trajectory of illness, which lead to experiencing escalated physical, psychological, and financial burdens [3]. Detrimental burdens of HF demand global efforts to improve the quality of HF management. Patients and/or their families face a wide spectrum of decision-making related to HF management, including therapeutic options [5,6]. Palliative discussion with advance directive (AD) documentation is one approach to reduce patients’ and their

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