Advance directives in the cardiac care unit

Area of Science:

• Cardiology
• Medical Ethics
• Patient Care

Background:

• Cardiovascular disease (CVD) mortality remains high and difficult to predict.
• Advance directives (AD) are recommended for heart failure patients but underutilized.
• Data on AD prevalence in serious cardiac disease is limited.

Purpose of the Study:

• To assess the prevalence of AD in cardiac care unit (CCU) patients.
• To compare AD prevalence and patient interest in information between CCU and oncology (ONC) patients.
• To identify factors influencing AD discussions in cardiovascular patients.

Main Methods:

• Survey of CCU patients on demographics, medical history, AD prevalence, and interest in AD information.
• Chart review for AD prevalence and interest in ONC patients for comparison.
• Tabulation of life-threatening cardiac diagnoses.

Main Results:

• AD prevalence was similar between CCU (26%) and ONC (31%) patients.
• Many CCU patients without AD did not recall prior discussions.
• CCU patients with heart failure or pulmonary hypertension were more likely to have been asked about AD.
• CCU patients without AD showed a significantly higher desire for more information (83% vs. 18%).

Conclusions:

• AD prevalence is low in CCU patients, with many unaware of prior discussions.
• Cardiovascular patients, particularly those without AD, actively seek information.
• Increased emphasis on AD discussions and integration into cardiovascular training is crucial.