Abstract 4126971: Advanced Care Planning in the CCU: What are the Numbers?

Introduction: Advanced care planning (ACP) is an important, though often neglected, part of medicine. It can promote goal-concordant care and improve communication between the medical team and patient. This is especially important in the intensive care unit, where important health decisions are made by patients and families. Previous studies have shown that patients and families are interested in ACP discussions, especially in intensive care units. Studies are limited, however, in analyzing the prevalence of these discussions prior to and during admission to the cardiac intensive care unit (CCU). Methods: This was a retrospective cohort study. Baseline demographics were collected on patients admitted or transferred to the CCU between January 1, 2022- July 1, 2022. The presence of any ACP (documentation including POLST forms, advance directives, or power of attorney forms) filled out prior to and during admission was recorded. Length of stay, outcome of admission, discharge disposition, and baseline comorbidity index using the Charlson Comorbidity Index (CCI) were also recorded. Transplant patients, patients admitted for transplant, and patients who underwent multiple admissions were excluded from the study. Results: Between January and July, 400 patients met criteria for inclusion. The average age was 67, with males accounting for 62% of patients. The average CCI amongst these patients was 6.95. Of the 400 patients, 31 had ACP completed prior to their admission (7.75%). Out of the 369 patients who did not have ACP in place upon admission, 9 had ACP completed during their stay in the CCU (2.44%). There was no difference in CCU hours amongst those who had ACP prior to admission compared to those who did not (p=.9). There was, however, a difference among CCI index: those with ACP prior to admission had an average CCI of 9.94 compared to 6.7 in those without ACP (p<.001). Conclusions: Patients at risk of cardiac-related mortality can benefit from ACP discussions prior to the onset of critical illness; however, only a small fraction of patients admitted to the CCU have proper documentation of this process. Inpatient and outpatient ACP can target at-risk patients to improve both the conversation and documentation of patient values and treatment preferences. Possible interventions to provide this care include physician education, consistent discussion of ACP during rounds, or flagging patients without ACP in the EMR.