| Title |
The Effect of Advance Care Planning on Heart Failure: a Systematic Review and Meta-analysis
|
|---|---|
| Published in |
Journal of General Internal Medicine, November 2019
|
| DOI | 10.1007/s11606-019-05482-w |
| Pubmed ID | |
| Authors |
Markus Schichtel, Bee Wee, Rafael Perera, Igho Onakpoya |
| Abstract |
Advance care planning is widely advocated to improve outcomes in end-of-life care for patients suffering from heart failure. But until now, there has been no systematic evaluation of the impact of advance care planning (ACP) on clinical outcomes. Our aim was to determine the effect of ACP in heart failure through a meta-analysis of randomized controlled trials (RCTs). We searched CINAHL, Cochrane Central Register of Controlled Trials, Database of Systematic Reviews, Embase, ERIC, Ovid MEDLINE, Science Citation Index and PsycINFO (inception to July 2018). We selected RCTs including adult patients with heart failure treated in a hospital, hospice or community setting. Three reviewers independently screened studies, extracted data, assessed the risk of bias (Cochrane risk of bias tool) and evaluated the quality of evidence (GRADE tool) and analysed interventions according to the Template for Intervention Description and Replication (TIDieR). We calculated standardized mean differences (SMD) in random effects models for pooled effects using the generic inverse variance method. Fourteen RCTs including 2924 participants met all of the inclusion criteria. There was a moderate effect in favour of ACP for quality of life (SMD, 0.38; 95% CI [0.09 to 0.68]), patients' satisfaction with end-of-life care (SMD, 0.39; 95% CI [0.14 to 0.64]) and the quality of end-of-life communication (SMD, 0.29; 95% CI [0.17 to 0.42]) for patients suffering from heart failure. ACP seemed most effective if it was introduced at significant milestones in a patient's disease trajectory, included family members, involved follow-up appointments and considered ethnic preferences. Several sensitivity analyses confirmed the statistically significant direction of effect. Heterogeneity was mainly due to different study settings, length of follow-up periods and compositions of ACP. ACP improved quality of life, patient satisfaction with end-of-life care and the quality of end-of-life communication for patients suffering from heart failure and could be most effective when the right timing, follow-up and involvement of important others was considered. |
X Demographics
The data shown below were collected from the profiles of 10 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 3 | 30% |
| Spain | 1 | 10% |
| Unknown | 6 | 60% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 9 | 90% |
| Science communicators (journalists, bloggers, editors) | 1 | 10% |
Mendeley readers
The data shown below were compiled from readership statistics for 186 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 186 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 16 | 9% |
| Researcher | 15 | 8% |
| Other | 13 | 7% |
| Student > Bachelor | 13 | 7% |
| Student > Doctoral Student | 8 | 4% |
| Other | 30 | 16% |
| Unknown | 91 | 49% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 39 | 21% |
| Nursing and Health Professions | 19 | 10% |
| Psychology | 8 | 4% |
| Unspecified | 4 | 2% |
| Computer Science | 3 | 2% |
| Other | 16 | 9% |
| Unknown | 97 | 52% |
Attention Score in Context
This research output has an Altmetric Attention Score of 21. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 10 September 2022.
All research outputs
#1,710,638
of 24,831,063 outputs
Outputs from Journal of General Internal Medicine
#1,332
of 8,025 outputs
Outputs of similar age
#36,359
of 366,731 outputs
Outputs of similar age from Journal of General Internal Medicine
#41
of 217 outputs
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