Abstract
Advance care planning (ACP) is a key element of palliative care even in patients with heart failure (HF); however, the complexity of the clinical trajectory hampers its early introduction. We retrospectively evaluated the state of implementation and the quality of ACP from the penultimate hospitalization in patients with HF who died after repeated hospitalizations. Of the 1117 patients admitted to Saga University Hospital from 2007 to 2016, we excluded 934 patients who survived after discharge or changed hospital, 78 patients who died for a reason other than HF, 42 patients who died during their first HF hospitalization, and 23 patients who died during hospitalization in another hospital. The electronic medical records of the remaining 40 patients were evaluated by three trained physicians on the recently provided 12 recommended elements of ACP, using a 5-point Likert scale (1 = very poor to 5 = excellent). The mean ratings of the 12 ACP elements ranged from 1.0 to 1.9. A do not attempt resuscitation (DNAR) order was issued to 10 patients (25%) just before they died. Of the remaining 30 patients not issued a DNAR order, cardiopulmonary resuscitation was attempted for 23 (76.7%) patients. Among patients with HF who eventually died after repeated hospitalizations, ACP even after the penultimate hospitalization was not evaluated highly. It resulted in a DNAR order in the last few days, a CPR as if their death was sudden and unexpected at the final moment, or CPAOA.
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Dr. Asaka and Dr. Kotooka have belonged to an endowed chair from Asahi Kasei corporation since 2017 to 2019, and 2017 to 2020, respectively. All authors have no any relationship with industry and financial associations within the past 12 months that might pose a conflict of interest in connection with the submitted article.
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The study protocol was approved by the institutional review board of Saga University Hospital. Reference number; 2018-10-expedite-03.
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Asaka, M., Kotooka, N., Yajima, A. et al. Advance care planning from the penultimate hospitalization in patients with end-stage heart failure: a single-center, 10-year experience. Heart Vessels 36, 1290–1297 (2021). https://doi.org/10.1007/s00380-021-01807-0
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DOI: https://doi.org/10.1007/s00380-021-01807-0