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Implementing Advance Care Planning in Heart Failure Patients

Wednesday, October 6, 2021

In 2015, the worldwide prevalence of heart failure (HF) was estimated to be approximately 40 million people. Although the clinical condition of heart failure is sometimes stable for a long time, it may change suddenly. When a person’s heart condition worsens, in many cases, they require urgent and intensive care management. In this situation, people with HF and their families might not be able to contemplate treatment and care options that take into account the person’s values and care preferences. 

An increasing proportion of patients suffering from refractory HF require palliative care. Improving quality of life for these patients is a fundamental goal of HF management in national and international guidelines. Essential elements of palliative care often include patient and family-centred communication, patient and family education about illness trajectory and prognosis, goals of care and advance care planning (ACP). ACP can play a significant role in identifying early palliative care needs and preparing for the end of life

It is important to discuss advance care planning not only when a person’s clinical condition is exacerbated, but early in the disease process. The American Heart Association (AHA) has emphasised the importance of goals of care discussions with patients to plan for future care according to the patient’s values and preferences, as well as current clinical status such as symptom burden and quality of life, potential treatment options and prognosis, as an annual heart failure review. The goal of ACP is to ensure that the care a person receives is consistent with their goals, values and preferences.

The discussion component of ACP may include an individual’s family members, surrogate decision‐makers, and key stakeholders involved in their care, since they best understand the person’s values, goals, and care preferences. In the event that an individual loses their capacity to make informed decisions, it becomes the responsibility of the surrogate decision‐makers or healthcare agents to direct medical care in keeping with the person’s wishes. 

A recent systematic review of key factors for successful implementation of interventions intended to support Advance Care Planning in healthcare settings include: 

  • using trained facilitators
  • conducting a patient-centred discussion
  • Educating patients in communicating their EOL preferences
  • the involvement of the family
  • correctly filing and communicating the ACP documentation with all parties

The review affirmed the importance of using trained facilitators and designing multiple ACP components to improve patient outcomes. Similarly, it noted that improvements in individuals QOL outcomes were due to a comprehensive palliative care program that included multiple ACP components: working as a multidisciplinary team, clear referral guidelines and involvement of carers and patients alike. 

Iris Premier is an innovative, high-touch Advance Care Planning solution designed to engage seriously ill members to better align their goals of care with an individual approach to healthcare services. Our team of specially trained ACP experts provide telehealth consultations when it’s convenient (daytime, evening or weekends) for individuals and their families to facilitate highly individualized care planning discussions and provide disease specific education. 

Our tech enabled consultation process allows our experts to document and generate state specific directives and goals of care summaries, which are then widely distributed to their care teams and family members. Our facilitators also address symptoms and other medical care needs, help uncover social determinants of health, and needs of caregivers. This approach enables better care coordination, enhances the member experience and improves healthcare outcomes.

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