Advance Care Planning Documentation and Intensity of Care at the End of Life for Adults With Congestive Heart Failure, Chronic Kidney Disease, and Both Illnesses.
J Pain Symptom Manage
; 63(2): e168-e175, 2022 02.
Article
em En
| MEDLINE
| ID: mdl-34363954
ABSTRACT
CONTEXT Heart failure (HF) and chronic kidney disease (CKD) are associated with high morbidity and mortality, especially in combination, yet little is known about the impact of these conditions together on end-of-life care. OBJECTIVES:
Compare end-of-life care and advance care planning (ACP) documentation among patients with both HF and CKD to those with either condition.METHODS:
We conducted a retrospective analysis of deceased patients (2010-2017) with HF and CKD (nâ¯=â¯1673), HF without CKD (nâ¯=â¯2671), and CKD without HF (nâ¯=â¯1706), excluding patients with cancer or dementia. We compared hospitalizations and intensive care unit (ICU) admissions in the last 30 days of life, hospital deaths, and ACP documentation >30 days before death.RESULTS:
39% of patients with HF and CKD were hospitalized and 33% were admitted to the ICU in the last 30 days vs. 30% and 28%, respectively, for HF, and 26% and 23% for CKD. Compared to patients with both conditions, those with only 1 were less likely to be admitted to the hospital [HF adjusted odds ratio (aOR) 0.72, 95%CI 0.63-0.83; CKD aOR 0.63, 95%CI 0.53-0.75] and ICU (HF aOR 0.83, 95%CI 0.71-0.94; CKD aOR 0.68, 95%CI 0.56-0.80) and less likely to have ACP documentation (aOR 0.53, 95%CI 0.47-0.61 and aOR 0.70, 95%CI 0.60-0.81).CONCLUSIONS:
Decedents with both HF and CKD had more ACP documentation and received more intensive end-of-life care than those with only 1 condition. These findings suggest that patients with co-existing HF and CKD may benefit from interventions to ensure care received aligns with their goals.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Planejamento Antecipado de Cuidados
/
Insuficiência Renal Crônica
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Insuficiência Cardíaca
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Adult
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Humans
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article