Heart Failure Patients Skipping Advance Directives

Most heart failure patients do not have advance directives

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Patients with heart failure are at a high risk of dying. Despite this fact, less than half of heart failure patients have advance directives dictating end-of-life interventions they want avoided.

Advance directives, also known as living wills, allow patients to make their wishes regarding end-of-life care clear ahead of time.

"Complete an advance directive early even if you don't think you need one."

S.M. Dunlay, MD, a lead researcher from the division of cardiovascular diseases at the Mayo Clinic in Minnesota, found that only 41 percent of heart failure patients have advance directives and even fewer had expressed preferences about specific treatments or life-saving measures.

Researchers enrolled 608 consecutive heart failure patients in Minnesota between October 2007 and October 2011 into a longitudinal study. Patients were an average age of 74, and slightly more than half were men. During an average follow up of one year and eight months, 27 percent of patients died.

Investigators reviewed advance directives completed prior to study enrollment and hospitalization during the month before patients died.

Though a low percentage of patients had advance directives, researchers found that 90 percent had appointed a proxy decision maker capable of making health decisions for them in the event they would be unable to make those decisions themselves.

They also found that 41 percent had addressed wishes regarding cardiopulmonary resuscitation (CPR), while 39 percent had addressed mechanical ventilation, or assisted breathing. Only 10 percent had made a decision regarding dialysis.

Heart failure patients were more likely to have an advance directive on file if they were older, suffered kidney dysfunction or were also diagnosed with cancer.

Harlan M. Krumholz, MD, editor-in-chief of the Journal Watch Cardiology Editorial Board and the Harold H. Hines, Jr., Professor of Medicine in the Section of Cardiovascular Medicine at the Yale University School of Medicine, noted that the number of advance directives among heart failure patients was "rather light" in one of the most advanced health systems in the country.

"We work very hard to help our patients recover from clinical events, but we need to place equal emphasis on ensuring that the care they get is the care they prefer. This study reveals an important area for future quality improvement," said Dr. Krumholz.

The study was recently published in Circulation: Cardiovascular Quality and Outcomes.

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Review Date: 
May 31, 2012
Last Updated:
May 31, 2012