title: How aware of advanced care directives are heart failure patients, and are they using them?
abstract: BACKGROUND
  The increasing prevalence of heart failure and its unpredictable trajectory highlight the need for patients to make their end-of-life care wishes known using advanced care directives (ACDs). The paucity of literature addressing heart failure patients' decision-making processes and knowledge of ACDs underscores the need for investigation. The purposes of this study were to (1) determine patients' awareness, comprehension, and utilization of ACDs and (2) determine their knowledge of the process of cardiopulmonary resuscitation and their current resuscitation preference.
  
  
  METHODS
  A prospective, single-centre study was designed to collect quantitative data addressing patients' understanding of ACDs and cardiopulmonary resuscitation as well as their current resuscitation preference. Patients who consented were interviewed using a semistructured questionnaire. Data were analyzed using descriptive statistics.
  
  
  RESULTS
  Of the 41 participants, 76% did not know what ACDs were and fewer recalled discussing them with their physician. Nearly 80% of the 37 queried participants would have preferred to discuss ACDs. More than 75% of participants wanted full resuscitation if they were to require it at this time. Most participants had not documented their resuscitation preference, and only slightly over half said their substitute decision maker was aware of their preference. Among the 19 with an implantable cardioverter-defibrillator, nearly half would want it deactivated should their condition worsen. Only 2 participants recalled having discussed this option with their physician.
  
  
  CONCLUSIONS
  There remains a lack of knowledge and utilization of ACDs among this heart failure population. Participants' preferences highlight the importance of discussing ACDs and exploring resuscitation preferences early and often in heart failure.
authors.affiliation: Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Marlena V
authors.initials: MV
authors.lastname: Habal
authors.forename: Vaska
authors.initials: V
authors.lastname: Micevski
authors.forename: Sarah
authors.initials: S
authors.lastname: Greenwood
authors.forename: Diego H
authors.initials: DH
authors.lastname: Delgado
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Ross
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D016223:Advance Directives; D000368:Aged; D001293:Attitude to Death; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D016638:Critical Illness / Q000401:mortality; D003430:Cross-Sectional Studies; D003657:Decision Making; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009864:Ontario; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult