Clinical InvestigationAcute Ischemic Heart DiseaseAdvance directives in the cardiac care unit
Section snippets
Methods
This study was approved by the local institutional review board. Patients able to participate in an interview in English who had been admitted to a cardiac care unit (CCU) at an academic medical center were recruited from May 2005 to May 2006. Patients were approached without regard for diagnosis or length of stay. The brief survey instrument included questions on demographics, medical history, outpatient physicians, whether the patient had executed an AD, and whether the patient recalled being
Results
Of 118 patients approached in the CCU, 112 agreed to participate (response rate = 95%). The average age was 58 ± 16 years, with 47 women (42%) (Table I). There were 73 African Americans, 29 whites, and 4 Hispanics. Racial determination was unavailable for 6 patients. The highest level of education attained was junior high for 8 (7%), high school for 56 (50%), at least college for 47 (42%), and unknown for 1 (<1%). Seventy (63%) patients reported having a primary care physician (internist,
Main findings
Our study found a low prevalence of AD among patients admitted to a CCU, comparable with that among patients admitted with oncologic/hematologic diagnoses. Almost one third of CCU patients had no recollection of prior AD discussions, despite a record of multiple hospitalizations. Patients with serious cardiac disease were more likely to indicate an interest in more information about AD than were patients with cancer.
Advanced care planning in cardiology
The development of lifesaving cardiovascular technologies and medications in
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Advance Care Planning and Goals of Care Communication in Older Adults with Cardiovascular Disease and Multi-Morbidity
2016, Clinics in Geriatric MedicineCitation Excerpt :A recent review found that absent, delayed, or inadequate ACP communication was associated with negative outcomes, including poor quality of life and anxiety, family distress, prolongation of the dying process, undesired hospitalization, patient mistrust of the health care system, physician burnout, and high costs.9 Furthermore, there are low rates of advance directive completion in patients with heart failure (41%), severe aortic stenosis (47%), or individuals admitted to a cardiac care unit (26%).21–23 Even when an advance directive exists, there is still poor correlation between what individuals state in an advance directive, what is documented in the medical record, and the care received.
How to discuss goals of care with patients
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Data presented in poster formats at the American College of Cardiology Scientific Sessions, Atlanta, GA, March 14, 2006, and at the Seventh Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, Washington, DC, May 8, 2006.
This study involved no external funding, sponsorship, or grant support.