Abstract 13306: Advanced Care Planning in Persons Who Die From Heart Disease
Introduction: The unpredictable trajectory of persons dying from cardiovascular disease (CVD) may make planning for future care challenging. In order to target quality improvement (QI) efforts, it is necessary to identify factors associated with advanced care planning (ACPing) in CVD.
Methods: The Health Retirement Survey (a nationally representative sample) provided data for a secondary data analysis of 1304 individuals’ ≥65 years of age that died of CVD from 2002-2012. Proxies of decedents reported ACPing activities (identifying a durable power of attorney for health care [DPOA_HC], completing a living will, or engaging in a conversation about care preferences at end of life (EoL). Demographic and clinical factors were also recorded.
Results: Proxies reported 78% of decedents engaged in some level of ACPing (60% had a DPOA_HC, 56.5% had a conversation about EoL treatment preferences, and 47.3% completed a living will). In bivariate analysis, being older, female, Caucasian, widowed, dying at home/hospice/other, having higher income or education, and more symptoms were associated with any type of ACPing (chi-squared test p-value ranges between <0.000 and 0.028). In the multivariate regression model, older age (OR=1.026, 95%CI [1.002, 1.052], p=0.037), Caucasian race (OR=1.754, 95%CI [1.126, 2.735], p=0.013), more education (‘high school grad’: OR=1.723, 95%CI [1.151, 2.580], p=0.008; ‘some college’: OR=2.659, 95% CI [1.451, 4.871], p=0.002; ‘college grad’: OR=3.404, 95%CI [1.710, 6.774], p<0.000), higher income (‘$10,001-$88,000’: OR=1.670, 95%CI [1.000, 2.791], p=0.050; ‘>$88,000’: OR=2.012, 95%CI [1.150,3.520], p=0.014), and more symptom burden (OR=1.350, 95%CI [1.217, 1.498], p<0.000) were associated with any type of ACPing.
Conclusions: The majority of individuals dying of CVD participate in ACPing. QI efforts to improve ACPing should target non-Caucasian individuals with less education, less income, younger age, and lower symptom burden.
Author Disclosures: J.R. Goebel: None. O. Korosteleva: None. E.A. Ortega: None. T. Manning: None. Y.T. Lodebo: None.
- © 2016 by American Heart Association, Inc.