The Impact of Advance Directive Perspectives on the Completion of Life-Sustaining Treatment Decisions in Patients with Heart Failure: A Prospective Study.

Jinshil Kim,Minjeong An,Jae Lan Shim,Soon Yong Suh,Mi-Seung Shin,Seongkum Heo,Bong Roung Kim

doi:10.3390/jcm10245962

Abstract

Evidence for non-modifiable and modifiable factors associated with the utilization of advance directives (ADs) in heart failure (HF) is lacking. The purpose of this study was to examine baseline-to-3-month changes in knowledge, attitudes, and benefits/barriers regarding ADs and their impact on the completion of life-sustaining treatment (LST) decisions at 3-month follow-up among patients with HF. Prospective, descriptive data on AD knowledge, attitudes, and benefits/barriers and LSTs were obtained at baseline and 3-month follow-up after outpatient visits. Of 64 patients (age, 68.6 years; male, 60.9%; New York Heart Association (NYHA) classes I/II, 70.3%), 53.1% at baseline and 43.8% at 3-month follow-up completed LST decisions. Advanced age (odds ratio (OR) = 0.91, p = 0.012) was associated with less likelihood of the completion of LST decisions at 3-month follow-up, while higher education (OR = 1.19, p = 0.025) and NYHA class III/IV (OR = 4.81, p = 0.049) were associated with more likelihood. In conclusion, advanced age predicted less likelihood of LST decisions at 3 months, while higher education and more functional impairment predicted more likelihood. These results imply that early AD discussion seems feasible in mild symptomatic HF patients with poor knowledge about ADs, considering the non-modifiable and modifiable factors.

Highlights

Despite therapeutic advances in heart failure (HF), living with HF, which is characterized by chronic progressive illness, still involves high morbidity and mortality, resulting in a substantial global burden of care [1,2]
Knowledge and attitudes were significantly improved over time, the changes were not associated with the likelihood of the completion of life-sustaining treatment (LST) decisions at 3-month follow-up
Advanced age was associated with the less likelihood of the completion of LST decisions at 3-month follow-up, while higher education level and more functional impairment were associated with an increased likelihood

Summary

Introduction

Despite therapeutic advances in heart failure (HF), living with HF, which is characterized by chronic progressive illness, still involves high morbidity and mortality, resulting in a substantial global burden of care [1,2]. Under the circumstances of living with the deteriorating course of the illness, patients with HF are faced with a wide spectrum of decision-making for therapeutic and palliative care issues [3,4,5]. ACP is an ongoing communication process, which often begins with exploring an individual’s value on future health, evolves to ACP, and may or may not prepare any form of ADs, such as Durable Power of Attorney for Health Care or Physician. An AD, as part of ACP, is often prepared as a vehicle to empower an individual to plan their future care at end-of-life (EoL), which refers to time prior to imminent death, but of unpredictable duration [11].

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