Decision-Making Content of Advance Care Planning in Patients With Heart Failure: A Retrospective Cross-Sectional Study

Introduction Advance care planning (ACP) is a process in which individuals collaboratively discuss and share their values and wishes regarding future medical care. Domestic and international heart failure (HF) guidelines recommend early ACP for patients after HF diagnosis. Various issues remain unresolved, including insufficient preparedness on the part of patients and differences in perceptions of ACP among healthcare providers. Therefore, we aimed to examine the current status and issues of ACP by organizing the characteristics of the ACP decision-making content in patients with HF. Methods The patient characteristics and implementation of ACP were retrospectively investigated from the electronic medical records of patients with HF who had been admitted to a single university hospital and had undergone ACP. To examine the characteristics of recognition of HF stage and decision-making content according to differences in HF severity, patients were classified into stage C and stage D based on the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) HF staging system. Furthermore, within each stage, patients were categorized according to age, sex, and number of hospitalizations for HF, and the ACP decision-making content was summarized using descriptive statistics. Results The study included 177 patients with HF (131 with stage C; 46 with stage D). There were discrepancies in perceptions of ACCF/AHA HF stage among older patients with HF; only 19 (39.6%) of patients with HF stage C correctly identified their stage, and only five (21.7%) of those with stage D did so. Despite demographic differences, 12 (85.7%) of respondents were aware of the existence of a surrogate decision-maker; however, fewer than half had engaged in ACP-related discussions with a surrogate decision-maker. In addition, patients with HF stage D aged ≥65 years, patients who were male, and patients with a history of two or more hospitalizations for HF were each found to have more than half of individuals expressing a preference to spend the end-of-life period at home; however, fewer than half in any group had engaged in discussions about ACP with their surrogate decision-makers. Regarding impressions after ACP, 29 (87.9%) of those aged <65 years with stage C responded "good." Conclusions Older patients with HF had a gap in their perception of their HF stage. Despite Japan's family-centered decision-making culture, the current ACP implementation rate, including that of family members, is low. Therefore, medical staff should play a coordinating role in promoting ACP.