Abstract 9573: Advance Care Planning and Prognosis Education in Patients With Heart Failure: Insights from the NCDR PINNACLE Registry

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Introduction: Advance care planning (ACP) and prognosis education are key components of high-quality, patient-centered care in heart failure (HF) and associated with better patient-reported outcomes. While research suggests that these occur infrequently in HF, studies have been limited to small and regional samples. We examined the prevalence of documented ACP and prognosis/end-of-life education as well as their associations with healthcare utilization in a large national sample of outpatients with HF.

Method: Among patients with HF in the NCDR PINNACLE Registry enrolled between January 2013 and June 2018, we determined the proportion receiving ACP and prognosis education. T-tests and chi-squares were used to examine characteristics of ACP and prognosis education. In those over 65 who could be linked with Medicare claims data, adjusted multivariable linear and two-level hierarchical logistic regression modelss were conducted to examine the associations of ACP and prognosis education with inpatient and outpatient utilization. The first heart failure encounter for each patient was analyzed for presence of ACP and prognosis education.

Results: Among 1.6 million patients with HF (Mage = 68.6+14.3), approximately 34% received ACP, while only 2% received prognosis education. Rates of ACP and prognosis education were lower in women, patients in the northeast and rural areas, and those in NYHA classes III-IV. Both ACP and prognosis education were low overall among patients with cardiac devices. Among 276,916 patients linked to Medicare claims data (Mage = 77.2+7.8), ACP was associated with fewer outpatient visits (p < 0.001), and both a lower likelihood of 30-day all-cause (OR = 0.86; 95% CI = 0.82-0.90) and HF related admissions (OR = 0.78, 95% CI = 0.73-0.84). A similar pattern was observed for prognosis education.

Conclusions: Less than half of patients with HF had documented ACP and almost no patients had documented prognosis education, despite being quality metrics in PINNACLE. Further, these quality metrics were associated with lower healthcare utilization rates. Research is needed to better understand the factors that promote ACP and prognosis education, and the effects of these quality metrics on clinical and patient-reported outcomes.

Clinical Institute

Cardiovascular (Heart)




Center for Cardiovascular Analytics, Research + Data Science (CARDS)