Readiness of Advance Care Planning Among Patients With Cardiovascular Disease

Noriko Fukue; Emiko Naito; Masayasu Kimura; Kaoru Ono; Shinichi Sato; Akira Takaki; Yasuhiro Ikeda

doi:10.3389/fcvm.2022.838240

Readiness of Advance Care Planning Among Patients With Cardiovascular Disease

Front Cardiovasc Med. 2022 Jun 2:9:838240. doi: 10.3389/fcvm.2022.838240. eCollection 2022.

Authors

Noriko Fukue^{1

2}, Emiko Naito³, Masayasu Kimura¹, Kaoru Ono¹, Shinichi Sato¹, Akira Takaki¹, Yasuhiro Ikeda²

Affiliations

¹ Department of Cardiology, Tokuyama Medical Association Hospital, Shunan, Japan.
² Department of Cardiology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan.
³ Nursing Department, Tokuyama Medical Association Hospital, Shunan, Japan.

Abstract

Background: Advance care planning (ACP) is a widely advocated strategy to improve outcomes at end-of-life care for patients suffering from heart failure (HF). However, finding the right time to start ACP is challenging for healthcare providers because it is often a sensitive issue for patients with HF and their families. We interviewed patients with cardiovascular diseases regarding ACP readiness and investigated the relationship between the ACP desire and multiple clinical prognostic parameters.

Method: Eighty-one patients (average age 81.8 ± 10.3 years old, 42 men, 62 cases of HF) who introduced cardiac rehabilitation were inquired about previous ACP experience, a desire for ACP, understanding of their cardiovascular diseases, and lifestyle-associated questionnaires. Multiple logistic regression analyses were employed to identify the clinical parameters associated with ACP desire. Patients who desired ACP were also asked about their preferences for medical care at the end-of-life.

Results: Nine patients (11.1%) had previous experience with ACP, and 28 (34.6%) preferred to implement ACP. Patients who did not want to implement ACP were 54.3%. Patients with HF showed a higher acceptance rate of ACP (odds ratio [OR] 5.56, p = 0.015). Interestingly, patients harboring skeletal muscle frailty showed lower ACP acceptance, while patients with non-frailty rather positively wanted to implement ACP. Two types of prognosis evaluation scales, such as the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) risk score and the Japanese Version of Supportive and Palliative Care Indicators Tool (SPICT-JP), identified 31 patients (38.3%) needing ACP; however, 19 (61.3%) did not want ACP. The wish not to attempt resuscitation and life-prolonging treatment at the end-of-life reached approximately 70% among patients who requested ACP.

Conclusions: Although patients with HF tended to be ready for implementing ACP, the presence of skeletal muscle frailty was negatively associated with ACP preference. Indeed, patients who should be considered ACP were not carried out and did not desire it. Earlier introduction of ACP into patients before having skeletal muscle frailty may be considered.

Keywords: advance care planning; cardiovascular disease; end-of-life; predictive factors; readiness.