Social isolation and implementation of advanced care planning among hospitalized patients with heart failure

Article indépendant

KITAKATA, Hiroki | KOHNO, Takashi | KOHSAKA, Shun | FUJISAWA, Daisuke | NAKANO, Naomi | SEKINE, Otoya | SHIRAISHI, Yasuyuki | KISHINO, Yoshikazu | KATSUMATA, Yoshinori | YUASA, Shinsuke | FUKUDA, Keiichi

Background: The implementation of advance care planning (ACP) in heart failure management is insufficient. Social isolation (SI) could be a barrier to ACP initiation, albeit the relationship between SI and patients' preference for ACP or end-of-life care remains unknown. Methods and Results: We conducted a questionnaire survey, including assessments of SI using the 6-item Lubben Social Network Scale as well as patients' perspectives on ACP and end-of-life care. Of the 160 patients approached by our multidisciplinary heart failure team during admission, 120 patients (75.0%) completed the survey (median age, 73.0 years; men, 74.2%). A Cox proportional hazard model was constructed to elucidate the short-term (180-day) prognostic impact of SI. Overall, 28.3% of participants were at high risk for SI (6-item Lubben Social Network Scale score <12). High-risk patients had more negative attitudes toward ACP than those without (61.8% versus 80.2%; P=0.035). The actual performance of ACP conversation in patients with and without high risk were 20.6% and 30.2%, respectively. Regarding preference in end-of-life care, "Saying what one wants to tell loved ones" (73.5% versus 90.6%; P=0.016) and "Spending enough time with family" (58.8% versus 77.9%; P=0.035) were less important in high-risk patients. High risk for SI was associated with higher 180-day risk-adjusted all-cause mortality (hazard ratio, 7.89 [95% CI, 1.53-40.75]). Conclusions: In hospitalized patients with heart failure, high risk for SI was frequently observed. High-risk patients were associated with a negative attitude toward ACP, despite higher mortality. Further research is required to establish an ideal approach to provide ACP in socially vulnerable patients.

http://dx.doi.org/10.1161/JAHA.122.026645

Voir la revue «Journal of the American Heart Association, 11»

Autres numéros de la revue «Journal of the American Heart Association»

• Description
• Sujet/Public
• Outil
• Outil d'anticipation
• Gestion