Association between Advance Directives and Invasive Life Support Use at End of Life: A Retrospective Cohort Study

Area of Science:

• Cardiology
• Geriatrics
• Medical Ethics

Background:

• Invasive life support is frequently used in end-of-life care.
• Emergency decisions often conflict with patient and family end-of-life preferences.

Purpose of the Study:

• To investigate the association between advance directives (ADs) and the utilization of invasive life support.
• To determine if documented ADs influence endotracheal intubation and chest compression use.

Main Methods:

• A retrospective cohort study analyzed data from 139 deceased cardiac care unit patients.
• Patients were included if they died of cardiac causes, excluding intraoperative or early admission deaths.

Main Results:

• Patients with advance directives (ADs) showed significantly lower odds of receiving endotracheal intubation and chest compressions (P < 0.001).
• Older age and heart failure history were linked to reduced intubation.
• Nighttime deaths were associated with higher intubation rates (56.3%) compared to daytime deaths (36.8%).

Conclusions:

• Explicitly documented ADs are independently associated with decreased invasive life support.
• Nighttime death emerged as a risk factor for aggressive resuscitation, indicating a systemic bias.
• Systematic procedures for AD recording and access are vital for aligning end-of-life care with patient wishes.