Advance directive screening among veterans with incident heart failure: Comparisons among people aging with and without HIV.
Kristie M Walenczyk, Casey E Cavanagh, Melissa Skanderson and 5 others
PMID 37023581WHAT IT FOUND
About half of Veterans with new heart failure had documented advance-directive screening in the next year.
Hospitalization and palliative care contact, not cardiology visits, were associated with more screening. Among those who died within a year, more than half had none.
Key findings
01AD screening in the year after incident HF was documented for 53.5% of people aging with HIV and 48.2% of people aging without HIV, a significant aggregate difference.
02After adjustment, palliative care contact and inpatient hospitalization were associated with higher AD screening, while cardiology encounters were not associated with screening.
03Among Veterans who died within one year of incident HF, 93 of 209 people aging with HIV and 178 of 391 people aging without HIV had received AD screening.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
AD screening was inferred from EHR note titles, so conversations not documented or embedded in other notes may have been missed. The study could not tell what was discussed, whether an AD was completed, or whether directives were used or followed. Researchers could not identify which provider type, including nurses, performed screening or how many contacts occurred with each healthcare setting. The sample was mostly men in the Veterans Health Administration, so results may not apply to women or other health systems. Because this was an observational record review, associations do not prove that hospitalization, palliative care, HIV status, or other factors caused more AD screening.
Declared interests
The supplied metadata indicates extramural NIH research support. The article text supplied here does not include an author conflict-of-interest declaration.
The easy way to misread this
Do not read AD screening as advance directive completion or goal-concordant care. Screening was broadly defined from note titles and could include only information or discussion. The study did not know whether directives were completed, used, or followed.