Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2020 Sep;13(9):e006502.
doi: 10.1161/CIRCHEARTFAILURE.119.006502. Epub 2020 Sep 2.

Prognostic Awareness and Goals of Care Discussions Among Patients With Advanced Heart Failure

Laura P Gelfman  1   2 , Rebecca L Sudore  3   4   5 , Harriet Mather  1 , Karen McKendrick  1 , Mathew D Hutchinson  6 , Rachel J Lampert  7 , Hannah I Lipman  8   9 , Daniel D Matlock  10   11 , Keith M Swetz  12 , Sean P Pinney  13 , R Sean Morrison  1   2 , Nathan E Goldstein  1   2
Affiliations
Multicenter Study

Prognostic Awareness and Goals of Care Discussions Among Patients With Advanced Heart Failure

Laura P Gelfman et al. Circ Heart Fail. 2020 Sep.

Abstract

Background: Prognostic awareness (PA)-the understanding of limited life expectancy-is critical for effective goals of care discussions (GOCD) in which patients discuss their goals and values in the context of their illness. Yet little is known about PA and GOCD in patients with advanced heart failure (HF). This study aims to determine the prevalence of PA among patients with advanced HF and patient characteristics associated with PA and GOCD.

Methods: We assessed the prevalence of self-reported PA and GOCD using data from a multisite communication intervention trial among patients with advanced HF with an implantable cardiac defibrillator at high risk of death.

Results: Of 377 patients (mean age 62 years, 30% female, 42% nonwhite), 78% had PA. Increasing age was a negative predictor of PA (odds ratio, 0.95 [95% CI, 0.92-0.97]; P<0.01). No other patient characteristics were associated with PA. Of those with PA, 26% had a GOCD. Higher comorbidities and prior advance directives were associated with GOCD but were of only borderline statistical significance in a fully adjusted model. Symptom severity (odds ratio, 1.77 [95% CI, 1.19-2.64]; P=0.005) remained a robust and statistically significant positive predictor of having a GOCD in the fully adjusted model.

Conclusions: In a sample of patients with advanced HF, the frequency of PA was high, but fewer patients with PA discussed their end-of-life care preferences with their physician. Improved efforts are needed to ensure all patients with advanced HF have an opportunity to have GOCD with their doctors. Clinicians may need to target older patients with HF and continue to focus on those with signs of worsening illness (higher symptoms). Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01459744.

Keywords: comorbidities; heart failure; life expectancy; prevalence; prognosis.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Prognostic awareness and goals of care discussions among a sample of patients with advanced heart failure. Patients were enrolled in a clinical trial of a clinician-centered intervention to improve conversations about management of implantable defibrillators and advance care planning. The size of each shape is proportional to the number of people within the shape.
See this image and copyright information in PMC

References

    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr., Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL, American College of Cardiology F and American Heart Association Task Force on Practice G. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147–239. - PubMed
    1. Solano JP, Gomes B and Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage. 2006;31:58–69. - PubMed
    1. Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Saksena S, Waldo AL, Wilber D, Brown MW and Heo M. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med. 1996;335:1933–40. - PubMed
    1. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P and Messenger J. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346:1845–53. - PubMed
    1. Van Nooten G Medicare reimbursement for destination therapy. Artif Organs. 2004;28:526–8. - PubMed

Publication types

Associated data