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The Effect of Advance Care Planning on Heart Failure: a Systematic Review and Meta-analysis

Markus Schichtel1, Bee Wee2, Rafael Perera3

  • 1Department of Public Health and Primary Care, Primary Care Unit, University of Cambridge, Cambridge, UK. ms2591@medschl.cam.ac.uk.

Journal of General Internal Medicine
|November 14, 2019
PubMed

Insights

Advance care planning (ACP) significantly improves quality of life, patient satisfaction, and end-of-life communication for heart failure patients. Optimal effectiveness is achieved through timely introduction, family involvement, and personalized follow-up.

Area of Science:

  • Cardiology
  • Palliative Care
  • Health Services Research

Background:

  • Advance care planning (ACP) is recommended for improving end-of-life care in heart failure patients.
  • A systematic evaluation of ACP's impact on clinical outcomes was previously lacking.
  • This study aimed to assess the effect of ACP in heart failure via a meta-analysis of randomized controlled trials (RCTs).

Purpose of the Study:

  • To systematically evaluate the impact of advance care planning (ACP) on clinical outcomes in heart failure patients.
  • To synthesize evidence from randomized controlled trials (RCTs) on the effectiveness of ACP in heart failure management.
  • To identify factors influencing the effectiveness of ACP in improving patient outcomes.

Main Methods:

  • A comprehensive literature search was conducted across multiple databases (CINAHL, Cochrane, Embase, MEDLINE, etc.) up to July 2018.
  • Fourteen RCTs involving 2924 adult heart failure patients were included.
  • Data were extracted, risk of bias and evidence quality were assessed using Cochrane and GRADE tools, and pooled effects were calculated using random-effects models.

Main Results:

  • ACP demonstrated a moderate positive effect on quality of life (SMD, 0.38) and patient satisfaction with end-of-life care (SMD, 0.39).
  • A significant improvement was observed in the quality of end-of-life communication (SMD, 0.29).
  • ACP was most effective when initiated at key disease milestones, included family, involved follow-up, and considered ethnic preferences.

Conclusions:

  • Advance care planning (ACP) positively impacts quality of life, patient satisfaction, and communication quality in heart failure patients.
  • The effectiveness of ACP is enhanced by strategic timing, family engagement, consistent follow-up, and cultural sensitivity.
  • ACP is a valuable intervention for improving end-of-life care experiences in individuals with heart failure.
Abstract

Keywords:
advance care planningeffectheart failuremeta-analysisoutcomespalliative caresystematic review

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