Advance Care Planning Before and After In-Hospital Cardiac Arrest

Objective: In-hospital cardiac arrest (IHCA) is a common event with high morbidity and mortality. This study seeks to evaluate advance care planning (ACP) among hospitalized patients who experienced IHCA. Design: Single center retrospective cohort study. Measurement and Main Results: The primary objective was to compare whether certain clinical characteristics are associated with a physician's likelihood of having an ACP discussion with patients who subsequently have IHCA. We found that older age, White race, and higher GO-FAR score were associated with increased ACP documentation. In multivariate regression modeling, numerically higher GO-FAR score, ICU patients, hospitalization for ≥7 days, and having a normal mental status were consistently associated with ACP documentation (OR ∼2 for all). There was a persistent trend, significant in some models, to lower likelihood of ACP documentation for non-White patients. Among patients who had predicted low-to-very low likelihood of IHCA survival, most (56%) had no ACP documentation prior to IHCA. Conclusions: We found that the factors associated with an increased likelihood of ACP were age, ICU location, longer LOS prior to IHCA, higher GO-FAR score and normal mental status before IHCA. There was a worrying trend toward lower rates of ACP documentation among non-White patients. The overall rate of completion of ACP was low in patients with poor predicted IHCA outcomes. Ongoing efforts should continue to engage all patients in ACP irrespective of demographics, and there may be a role for utilizing standardized prognostication models to encourage ACP.