[Knowledge about disease course and living wills among patients with heart failure]. / Conocimiento de la enfermedad y del testamento vital en pacientes con insuficiencia cardiaca.

INTRODUCTION AND OBJECTIVES: To determine the level of knowledge about possible disease outcomes and living wills among patients with heart failure (HF) treated in an emergency department and to evaluate their willingness to draw up a living will. METHODS: This cross-sectional, multicenter, noninterventional, prospective study included a consecutive series of patients. Patients' demographic and clinical characteristics were recorded. Once their symptoms were under control, patients were interviewed about their knowledge of and opinions about HF. The dependent variables were a good objective understanding of the disease and a willingness to draw up a living will, and factors associated with these variables were investigated. RESULTS: The study included 309 patients: 79% considered themselves well-informed, 51.5% really were well-informed, 39.8% wanted more information, and 54.7% wanted to participate more in decision-making. In addition, 13.3% knew what living wills involved, 4.9% had received information about them from their doctor, and 28.8% agreed to draw one up. There was an independent association between being objectively well-informed and willingness to draw up a living will. Moreover, the former was associated with admission to intensive care, feeling well-informed, and having participated sufficiently in decision-making; the latter with age <75 years, wanting more information, understanding what a living will involved, and the referral center. CONCLUSIONS: The knowledge possessed by HF patients about the natural history of their disease was suboptimal, as was their knowledge about living wills and their willingness to draw one up. Providing better information about these issues is an essential part of the doctor-patient relationship.

Conocimiento de la enfermedad y del testamento vital en pacientes con insuficiencia cardiaca / Knowledge about disease course and living wills among patients with heart failure

Introducción y objetivos. Investigar en pacientes con insuficiencia cardiaca atendidos en urgencias su conocimiento de las posibilidades evolutivas y del testamento vital (TV) y su predisposición a redactarlo. Métodos. Estudio transversal con inclusión prospectiva y consecutiva, multicéntrico, sin intervención. Se consignaron características clínico-demográficas de cada paciente y, tras el control de sus síntomas, se realizó una encuesta acerca de aspectos de conocimiento y opinión de su enfermedad. Como variables dependientes, se consideraron tener buen conocimiento objetivo de su enfermedad y la predisposición a redactar un TV. Se investigaron los factores asociados. Resultados. Se incluyó a 309 pacientes: el 79% se consideraba subjetivamente bien informado, el 51,5% lo estaba realmente, el 39,8% desearía más información y el 54,7%, participar más en la toma de decisiones; el 13,3% sabía en qué consistía un TV; al 4,9% su médico le había informado y el 28,8% se mostraba partidario de redactarlo. Estar objetivamente bien informado y estar dispuesto a redactar un TV se asociaron de forma recíproca e independiente; además, con la primera variable se asociaron el ingreso en intensivos, considerarse bien informado y haber participado suficientemente en la toma de decisiones, y con la segunda, tener menos de 75 años, desear más información, saber en qué consiste el TV y el centro de procedencia. Conclusiones. El conocimiento de los pacientes con insuficiencia cardiaca respecto a sus posibilidades evolutivas es subóptimo, como también lo es su conocimiento del TV y su predisposición a redactarlo. Debe mejorarse la información de estos aspectos como parte esencial de la relación médico-paciente (AU)

Introduction and objectives. To determine the level of knowledge about possible disease outcomes and living wills among patients with heart failure (HF) treated in an emergency department and to evaluate their willingness to draw up a living will. Methods. This cross-sectional, multicenter, noninterventional, prospective study included a consecutive series of patients. Patients’ demographic and clinical characteristics were recorded. Once their symptoms were under control, patients were interviewed about their knowledge of and opinions about HF. The dependent variables were a good objective understanding of the disease and a willingness to draw up a living will, and factors associated with these variables were investigated. Results. The study included 309 patients: 79% considered themselves well-informed, 51.5% really were well-informed, 39.8% wanted more information, and 54.7% wanted to participate more in decision-making. In addition, 13.3% knew what living wills involved, 4.9% had received information about them from their doctor, and 28.8% agreed to draw one up. There was an independent association between being objectively well-informed and willingness to draw up a living will. Moreover, the former was associated with admission to intensive care, feeling well-informed, and having participated sufficiently in decision-making; the latter with age <75 years, wanting more information, understanding what a living will involved, and the referral center. Conclusions. The knowledge possessed by HF patients about the natural history of their disease was suboptimal, as was their knowledge about living wills and their willingness to draw one up. Providing better information about these issues is an essential part of the doctorpatient relationship (AU)