Advance Directives Among Hospitalized Patients With Heart Failure
Advance Directives Among Hospitalized Patients With Heart Failure
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DOI：
10.1016/j.jchf.2014.07.016
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发表时间：
2015-02-01
影响因子：
13
通讯作者：
Quest, Tammie
中科院分区：
文献类型：
--
作者：
Butler, Javed;Binney, Zachary;Quest, Tammie
本研究的目的是评估因心力衰竭（HF）住院的患者中记录的预先指令（AD）的频率和相关性背景与HF患者讨论AD对于确定与患者的价值观和偏好一致的治疗目标以及促进医疗保健团队的沟通至关重要。2008年9月至2013年8月期间出院诊断为HF的初级或二级三级护理医院，以评估电子病历中是否存在AD。我们进行了分析，包括HF作为主要或次要入院诊断，HF仅作为主要入院诊断。构建多变量模型，调查记录ADs.RESULTS数据的独立预测因素，包括44,768从24,291例患者超过5年的入院。患者入院时的平均年龄为64.8 ± 15.9岁;其中47.9%为女性，51.8%为黑人。所有入院患者的中位住院时间为5（3 - 10）天; 12.7%的患者有记录的AD。年龄较大、女性、白色种族、较高的社会经济地位、较高的住院不良结局风险、住院时间>= 5天、临终关怀出院、姑息治疗咨询和不复苏命令均与记录的AD发生率显著较高相关。随着时间的推移，AD显着增加，但超过80%的患者没有AD的医疗记录在研究结束时periods.Conclusions在不同人群的HF住院患者，大多数没有记录的AD的医疗记录。尽管有几个因素与较高的概率相关，但所有HF患者亚组都存在改善AD记录的主要机会。(C)2015年美国心脏病学院基金会。
OBJECTIVES The purpose of this study was to assess the frequency and correlates of documented advance directives (ADs) among patients hospitalized for heart failure (HF).BACKGROUND Discussing ADs with patients with HF is critical for identifying treatment goals consistent with patients' values and preferences and for facilitating health care team communication.METHODS We retrospectively identified electronic medical records of adult patients admitted to 2 large tertiary care hospitals with either the primary or secondary discharge diagnosis of HF from September 2008 to August 2013 to assess the presence of ADs in electronic medical records. We performed analyses including HF as either the primary or secondary admission diagnosis and HF as the primary admission diagnosis only. Multivariable models were constructed to investigate independent predictors of documented ADs.RESULTS Data included 44,768 admissions from 24,291 individual patients over 5 years. Mean age of patients at admission was 64.8 +/- 15.9 years; 47.9% of these patients were female, 51.8% were black. The median length of stay for all admissions was 5 (3 to 10) days; 12.7% of patients had documented ADs. Older age, female sex, white race, higher socioeconomic status, higher risk for adverse in-hospital outcomes, length of stay >= 5 days, hospice discharge, palliative care consultation, and a do-not-resuscitate order were all associated with a significantly higher chance of having documented ADs. A significant increase in ADs over time was noted, but more than 80% of patients did not have ADs in medical records at the end of the study period.CONCLUSIONS In a diverse population of hospitalized patients with HF, most did not have a documented AD in the medical records. Although several factors were associated with a higher probability, major opportunities exist for all subgroups of patients with HF to improve documentation of ADs. (C) 2015 by the American College of Cardiology Foundation.