Does advance care planning in addition to usual care reduce hospitalisation for patients with advanced heart failure: A systematic review and narrative synthesis
BACKGROUND: People with advanced heart failure have repeated hospital admissions. Advance care planning can support patient preferences, but studies in people with heart failure have not been assessed.AIM: To evaluate the literature regarding advance care planning and hospitalisation in heart failure.DESIGN: Systematic review and narrative analysis.(PROSPEROCRD42017059190)DATA SOURCES: Electronic databases were searched (1990 to23.03.2017); MEDLINE(R), Cochrane Library, CINAHL, and Scopus. Four journals were hand searched. Two independent researchers screened against eligibility criteria. One reviewer extracted all data and a sample by a second. Quality was assessed by Cochrane Risk of Bias or the Critical Appraisal Skills Programme Tool for Cohort Studies.RESULTS: 8/1713 articles were included representing 14,357 participants from in/outpatient settings from five countries. Two randomised-controlled trials and one observational study assessed planning as part of a specialist palliative care intervention; one randomised-controlled trial assessed planning in addition to usual cardiology care; one randomised-controlled trial and one observational study assessed planning in an integrated cardiology-palliative care model; one observational study assessed evidence of planning (advance directive) as part of usual care, and one observational study was a secondary analysis of trial participants coded Do Not Attempt Cardiopulmonary Resuscitation. Advance care planning i) reduced hospitalisation(5/7 studies), ii) increased referral/use of palliative services (4/4 studies), iii) supported deaths in the patient-preferred place (2/2 studies).CONCLUSIONS:Advance care planning as part of a specialist palliative care careintervention reduces hospitalisation. Preliminary studies of planning integrated into generic care, accessing specialist palliative care support if needed, are promising
