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Future Care Planning (FCP) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost. We assessed the feasibility, acceptability and tested a design of a randomised trial evaluating the impact of FCP in patients and carers. 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of >20% were randomly allocated to FCP or usual care for 12 weeks upon dis-charge and then crossed-over for the next 12 weeks. Quality of life, symptoms and anxie-ty/distress were assessed by questionnaire. Hospitalisation and mortality events were docu-mented for 6 months post-discharge. FCP increased implementation and documentation of key decisions linked to end-of-life care. FCP did not increase anxiety/distress (Kessler score -E 16.7 (7.0) vs D 16.8 (7.3), p=0.94). Quality of life was unchanged (EQ5D: E 0.54(0.29) vs D 0.56(0.24), p=0.86) while unadjusted hospitalised nights was lower (E 8.6 (15.3) vs D 11.8 (17.1), p=0.01). Qualitative interviews indicated that FCP was highly valued by patients, car-ers and family physicians.FCP is feasible in a randomised clinical trial in patients with acute high risk cardiac condi-tions. A Phase 3 trial is needed urgently.
|Publication status||Published - 19 Apr 2016|
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- 1 Finished
Phase 2 randomised trial of early versus delayed future care planning for patients with advanced heart disease
1/06/13 → 31/07/15