Guideline-Recommended Advance Care Planning, End-of-Life Education Occurs Infrequently in HF Care

Although advance care planning and end-of-life education are often recommended in heart failure (HF) care by professional organizations and consensus guidelines, these critical measures captured by the Veradigm Cardiology Registry (formerly the PINNACLE Registry) were found to occur infrequently, according to a letter published in Circulation: Cardiovascular Quality and Outcomes.

Casey E. Cavanagh, PhD, et al., examined both the prevalence of advance care planning and end-of-life education in patients with HF and variation depending on patient, clinic and provider characteristics. They evaluated 1,684,284 patients with HF from 348 outpatient academic and nonacademic cardiology practices in the U.S. from Jan. 1, 2013 through June 30, 2018.

Results showed that documentation of advance care planning was observed in 34.1% of patients, with a low rate of documentation among patients with left ventricular assist devices (34.1%) or other cardiovascular implantable electronic devices including pacemaker (35.2%), ICD (30.6%), CRT (35.2%) and CRT-D (35.9%).

When looking at end-of-life education, the authors noted a much lower incidence rate occurring in 1.9% of patients (similar rates for men and women). Breaking the data down by race, they found that Hispanic/Latino (0.3%) and Black patients (1.6%) had much lower rates of documented end-of-life education when compared to non-Hispanic/Latino (2.0%) and White patients (2.5%). Low documentation rates were also seen among patients with cardiovascular implantable electronic devices (pacemaker, 1.4%; ICD, 1.7%; CRT, 1.3%; CRT-D, 1.3%).

Researchers add that patients with NYHA class I-III HF had lower documentation of advance care planning in comparison to NYHA class IV patients (42-47% vs. 60.0%), and end-of-life education documentation was low in patients with NYHA class III (2.5%) or IV (1.4%) HF. However, the authors acknowledge that association between poor prognosis based on NYHA HF classification and documentation rates remains unclear due to high rates of missing data.

“Despite the importance of [advance care planning] and [end-of-life] discussions in patients with HF, this large contemporary outpatient evaluation reveals modest rates of [advance care planning] (<50%) and very low rates of [end-of-life] education (<2%), with substantial variation by patient and practice characteristics,” state the authors.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Prognosis, Electronics, Cardiology, Registries, Documentation, Pacemaker, Artificial, Heart Failure, Incidence, Outpatients, Prevalence, PINNACLE Registry, National Cardiovascular Data Registries

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