Heart to Heart Discussions: Characterizing Goals of Care Conversations for Advanced Heart Failure Patients Initiating Palliative Inotropes
Abstract
BACKGROUND: Guidelines recommend goals of care conversations (GOCC) and specialty palliative care at the time of initiation of palliative inotropes for advanced heart failure patients. The extent to which GOCC are occurring, the content of the GOCC and the frequency of palliative care involvement is unknown. METHODS: We conducted a retrospective chart review of all patients discharged from a tertiary medical center between October 2015 and April 2020 initiated on continuous palliative inotropes. RESULTS: We identified 53 patients who were discharged on continuous palliative inotropes. Most patients (46/53; 87%) had a documented GOCC including discussions around preferences for life-sustaining treatments, hospice, and/or prognosis. However, just over half (55%; 15/27) of patients with an ICD had a documented discussion regarding preferences for ICD deactivation. Patients seen by palliative care were more likely to have a documented discussion about ICD deactivation (68% vs 0%; p-value = 0.0098). Frequency of palliative care consultation and documented GOCC conversations increased over time. CONCLUSION: Although we observed overall high rates of documented GOCC, there is room for improving the rate of discussions with patients about whether they wish to have their ICD deactivated. Future research should test interventions to improve frequency of ICD discussions.