Advance Care Planning for Patients With Heart Failure in a Multiethnic South East Asian Cohort

Abstract

BackgroundLimited data in our multi-ethnic South East Asian society on the feasibility of advance care planning (ACP) where different cultures have disparate beliefs with regards to death.AimA pilot study for the feasibility of basic ACP for patients with mild heart failure.MethodsPatients were recruited from a heart failure clinic over a 4 month period if they are in New York Heart Association class I/II with no readmission in preceding 6 months.ResultsOf 58 patients, 83% had formal ACP while 17% declined to participate. Mean age was 57 years with predominance of male (72%). Ethnic distribution followed the national demographic (84% Chinese, 9% Indian, 7% Malay). The participation rate among the different ethnic groups were 86% for Chinese, 100% for Indians and 25% for Malay. For the participants, 90% had more than one ACP session with a mean duration of 60 min per session, and 17% had completed the ACP forms upon enrolment of the last patient. Significant challenges faced were low awareness of ACP among patients and caregivers as well as need for coordination across multiple disciplines.DiscussionThere is a high acceptance of ACP among patients with mild heart failure. But there is a disparity in the attitudes of different ethnic groups towards ACP where Malay are less willing to discuss it compared to Chinese and Indian.ConclusionOur study highlights the feasibility of implementing ACP in South East Asian patients with heart failure, and the need for further research on the observed impact of ethnicity.

Attitudes toward advance directives and prognosis in patients with heart failure: a pilot study

“…Such attitudes could be possible in ethnic differences. One study reported that Malays were less willing to participate in advance care planning discussion than Chinese and Indians [37]. In this study, the relationships of the AD attitudes and prognosis of HF with the completion of the K-AD model and each of the four treatment directives, respectively, were preliminarily examined.…”