Author + information
- Nancy H. Klein,
- Whitney Osborne,
- Rachel Steury,
- Seiji Ito,
- Ruth Phillippi and
- Anitha John
Background: It is recommended that all patients (pts), especially with a chronic health condition, have some form of advanced directives (AD) as part of their long-term health planning. Barriers to AD completion in the adult congenital heart disease (ACHD) population are not well defined; we evaluated factors associated with completion of AD in the general ACHD population.
Methods: From Sep 2015 to Aug 2016, 341 pts (46% male) completed clinical questionnaires regarding completion of a living will (LW), durable power of attorney (POA) or discussion regarding end-of-life care with family. Questionnaires also included: age, gender, race, education, marital status, children, and depression and anxiety screening (PHQ-4 inventory).
Results: Mean age was 31 ± 10 years (yrs). Disease complexity was classified as: mild (17%), moderate (52%), and severe (31%). Fifty eight pts (17.0%) had a LW or POA, 63 pts (18.5%) had discussed their wishes with family, and 220 pts (64.5%) did not have an AD. 37 pts (10.9%) had both discussed their wishes with family and also had a LW and/or POA completed. Advanced education (p<0.01), older age (p<0.01), white race (p=0.01), and living with a spouse (p<0.01) or child (p=0.02) was significantly associated with completion of a LW or POA. Disease complexity was not significant associated with completion of AD (p=0.06). Eighteen pts (5%) had screening depression scores ≥ 3 and 38 pts (11%) had screening anxiety scores ≥ 3, warranting further work-up. There was no correlation with AD completion and anxiety or depression scores. After controlling for age, patients with an associate degree or higher were nearly twice as likely to have completed a LW, POA, or discussed with family (OR 1.8, 95% CI=1.3-2.5). Reasons for not completing AD included: lack of knowledge (n=26, 11.8%), no time for completion (n=18, 8.2%), and not knowing where to start (n=82, 37.3%).
Conclusions: ACHD patients have low rates of AD completion. Older patients with education higher than a high school diploma had higher rates of completion while disease severity had no association. Further education about the importance of AD is needed, with an emphasis on addressing potential disparities and access to resources.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Adult Patients With Congenital Heart Disease: How Do They Compare?
Abstract Category: 9. Congenital Heart Disease: Adult
Presentation Number: 1142-014
- 2017 American College of Cardiology Foundation