Advance care planning significantly improves quality of life for patients with heart failure, concludes the first systematic evaluation of published evidence on this topic, led by Dr Markus Schichtel at the Primary Care Unit, University of Cambridge.
The review shows that patients with heart failure who have had the opportunity to take part in advance care planning (ACP) experienced improvements in quality of life, satisfaction with end-of-life care and in the quality of end-of-life communication.
900,000 people in the UK suffer from heart failure and only the minority of that population have their palliative care needs addressed. ACP is widely advocated to improve palliative care for patients with heart failure but clinicians are hesitant to engage with ACP. As a result, only a minority of heart failure patients get the opportunity to think about the care they would want when, or if, their condition advances and they cannot express views or make decisions.
This review is the first to provide systematic evidence that ACP can improve clinical outcomes for patients in heart failure. The authors analysed data from 14 randomised controlled trials, which together included 2924 participants. Taking the data from all 14 studies, the researchers found that the patients who were offered ACP were statistically more likely to experience higher quality of life, and to express better satisfaction with their care. They were also more likely to indicate that communications with their clinicians were of higher quality.
ACP seemed most effective if it was introduced at significant milestones in a patient’s disease trajectory, included family members, involved follow-up appointments and considered ethnic preferences.
This meta-analysis shows that ACP can improve clinical outcomes in heart failure. Also, and maybe equally importantly, we were able to see which factors contribute to an effective engagement with ACP.”
– Dr Markus Schichtel, post-doctoral researcher at Cambridge Palliative and End-of-Life Care Group
This meta-analysis was part of Dr Schichtel’s doctoral studies at the Nuffield Department of Primary Care Health Sciences, Oxford.
M Schichtel, B Wee, R Perera, I Onakpoya, The effect of advance care planning in heart failure: a systematic review and meta-analysis Journal Gen Internal Medicine, 12 Nov 2019
See this NIHR Signal Schichtel M, Wee B, Perera R et al. Clinician-targeted interventions to improve advance care planning in heart failure: a systematic review and meta-analysis. Heart. 2019; May 24. doi: 10.1136/heartjnl-2019-314758.
Read How to help doctors discuss treatment options with heart failure patients and M Schichtel, B Wee, J MacArtney, S Collins, ‘Clinician barriers and facilitators to heart failure advance care plans: a systematic literature review and qualitative evidence synthesis’. BMJ Supportive and Palliative Care. DOI 10.1136/bmjspcare-2018-001747
Lucy Lloyd, Communications, Primary Care Unit
Image: Dr Jon Ferdinand at the Primary Care Unit