Abstract
Objectives: We aimed to investigate 1-year stability of preferences regarding cardiopulmonary resuscitation (CPR) and mechanical ventilation (MV) of patients with advanced COPD, chronic heart failure (CHF) or chronic renal failure (CRF), and to identify clinical determinants associated with these preferences.
Methods: 265 clinically stable outpatients with COPD, CHF or CRF were visited at baseline and every 4 months for 1 year, to assess preferences for CPR and MV. Generalized estimating equations were used to study the association between preferences and several potential predictors including co-morbidities, hospital admissions, health status (EQ5D), care dependency (CDS), mobility, depression (HADS-D) and anxiety (HADS-A).
Results: 78% of the patients completed 1-yr follow-up (64% men; mean (SD) age: 67 (13) yrs). CPR and MV preferences changed in 38% of the patients during follow-up. The odds ratio (95% CI) combining the time and factor effects show an association between preference for CPR and change in EQ5D (+1 pt: OR 1.7 (1.2-2.5)), CDS (+9 pt: OR 1.5 (1.2-1.9)), HADS-D (+6 pt: OR 0.5 (0.4-0.8)), HADS-A (+5 pt: OR 0.7 (0.5-0.9)) and change in marital status (single vs. living with partner: OR 0.5 (0.3-0.9)); and an association between preference for MV and change in EQ5D (+1 pt: OR 1.5 (1.1-2.2)), CDS (+9 pt: OR 1.5 (1.1-1.9)) and HADS-D (+6 pt: OR 0.6 (0.4-0.8)).
Conclusions: More than a third of outpatients with advanced COPD, CHF or CRF changed their preferences regarding CPR and/or MV during 1 year at least once. Regular re-evaluation of advance care planning is necessary when patients experience a change in health status, care dependency, mood status or marital status.
- © 2011 ERS
