How Aware of Advanced Care Directives Are Heart Failure Patients, and Are They Using Them?

A randomized controlled pilot trial to improve advance care planning for LVAD patients and their surrogates

“…In fact, all of the participants who engaged in the SPIRIT-HF discussion, completed all components, and were unanimous in their contention that it is beneficial to patients and families, and is an important, yet currently overlooked, part of care. Both of these findings, the lack of detailed advance care planning discussions, 15–17, 38 and the willingness of patients and surrogates to engage in them, 19, 39, 40 are consistent with previously reported findings. However, the interview data provide additional information about the participants’ perspectives on the most positive aspects, and the immediate outcomes of the conversation.…”

“…It will be important to consider assessment effects in any future intervention, whether the findings support the research hypothesis or not. 38 Employing a variety of outcome measures, both quantitative and qualitative would likely be helpful in understanding and explaining intervention effects.…”

Decision Making Among Persons Living With Heart Failure

“…10 Habal used a descriptive survey (N=41) to assess completion rates of wills. 11 A palliative care consultation significantly increased the completion of advanced directives from 28% to 47% (p=0.016) in the first study. 10 The majority of participants (76%) had completed a will in the study by Habal.…”

“…10 The majority of participants (76%) had completed a will in the study by Habal. 11 Sample sizes were small and samples were predominantly male in both studies.…”

Withdrawal of life-sustaining medical devices at the end of life

“…While the use of advance directives by those with heart failure is increasing, specific device related decision making remains the exception 2 3. However, preparedness planning for end of life care incorporating palliative care consultations has been shown to be of benefit in those being considered for LVAD therapy,4 and prospective preimplantation discussion about this issue is mandated in the position statement on implantable cardioverter defibrillator deactivation from the Heart Rhythm Society in the USA and supported by the European Heart Rhythm Association 5.…”