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Impact of a Formal Advance Care Planning Program on End-of-Life Care for Patients With Heart Failure: Results From a Randomized Controlled Trial.

Publication ,  Journal Article
Malhotra, C; Sim, D; Jaufeerally, FR; Hu, M; Nadkarni, N; Ng, CSH; Wong, G; Tan, BC; Lim, JF; Chuang, CY-T; Finkelstein, EA
Published in: J Card Fail
July 2020

BACKGROUND: There is no evidence on effectiveness of advance care planning (ACP) among patients with heart failure (HF). We examined the effect of an ACP program in facilitating end of life (EOL) care consistent with the preferences of patients with HF (primary aim), and on their decisional conflict, discussion with surrogates, illness understanding, anxiety, depression, and quality of life (secondary aims). METHODS: We randomized 282 patients with HF to receive ACP (n=93) or usual care (control arm, n=189). Primary outcomes were assessed among deceased (n=89) and secondary outcomes from baseline and 6 follow-ups conducted every 4 months. RESULTS: Deceased patients in the ACP arm were no more likely than those in control arm to have wishes followed for EOL treatments (ACP: 35%, Control: 44%; P= .47), or place of death (ACP: 52%, Control: 51%; P = .1.00). A higher proportion in the ACP arm had wishes followed for cardiopulmonary resuscitation (ACP: 83%, Control: 62%; P = .12). At first follow-up, patients with ACP had lower decisional conflict (β = -10.8, P< .01) and were more likely to discuss preferences with surrogates (β = 1.3, P = .04). ACP did not influence other outcomes. CONCLUSION: This trial did not confirm that our ACP program was effective in facilitating EOL care consistent with patient preferences. The program led to short-term improvements in the decision-making.

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Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

July 2020

Volume

26

Issue

7

Start / End Page

594 / 598

Location

United States

Related Subject Headings

  • Terminal Care
  • Quality of Life
  • Humans
  • Hospice Care
  • Heart Failure
  • Cardiovascular System & Hematology
  • Advance Care Planning
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1110 Nursing
 

Citation

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Malhotra, C., Sim, D., Jaufeerally, F. R., Hu, M., Nadkarni, N., Ng, C. S. H., … Finkelstein, E. A. (2020). Impact of a Formal Advance Care Planning Program on End-of-Life Care for Patients With Heart Failure: Results From a Randomized Controlled Trial. J Card Fail, 26(7), 594–598. https://doi.org/10.1016/j.cardfail.2020.01.015
Malhotra, Chetna, David Sim, Fazlur Rehman Jaufeerally, Meibo Hu, Nivedita Nadkarni, Clarice Shu Hwa Ng, Genevieve Wong, et al. “Impact of a Formal Advance Care Planning Program on End-of-Life Care for Patients With Heart Failure: Results From a Randomized Controlled Trial.J Card Fail 26, no. 7 (July 2020): 594–98. https://doi.org/10.1016/j.cardfail.2020.01.015.
Malhotra C, Sim D, Jaufeerally FR, Hu M, Nadkarni N, Ng CSH, et al. Impact of a Formal Advance Care Planning Program on End-of-Life Care for Patients With Heart Failure: Results From a Randomized Controlled Trial. J Card Fail. 2020 Jul;26(7):594–8.
Malhotra, Chetna, et al. “Impact of a Formal Advance Care Planning Program on End-of-Life Care for Patients With Heart Failure: Results From a Randomized Controlled Trial.J Card Fail, vol. 26, no. 7, July 2020, pp. 594–98. Pubmed, doi:10.1016/j.cardfail.2020.01.015.
Malhotra C, Sim D, Jaufeerally FR, Hu M, Nadkarni N, Ng CSH, Wong G, Tan BC, Lim JF, Chuang CY-T, Finkelstein EA. Impact of a Formal Advance Care Planning Program on End-of-Life Care for Patients With Heart Failure: Results From a Randomized Controlled Trial. J Card Fail. 2020 Jul;26(7):594–598.
Journal cover image

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

July 2020

Volume

26

Issue

7

Start / End Page

594 / 598

Location

United States

Related Subject Headings

  • Terminal Care
  • Quality of Life
  • Humans
  • Hospice Care
  • Heart Failure
  • Cardiovascular System & Hematology
  • Advance Care Planning
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1110 Nursing