Efficacy of an Advanced Care Planning Program in Advanced Heart FAilure
Efficacy of an Advanced Care Planning Program in Advanced Heart FAilure
An "Advanced Planning Program of Health Decisions" (APPHD) is a process of reflection and
 relationship between the patient, their relatives and health professionals. It is based on
 respect for patient's autonomy, to engage patients in making decisions about their disease so
 that the process is shared between the medical team, the patient and their relatives. Until
 now, it has not been measured whether the APPHD is effective and, therefore, really fulfills
 its purpose
BACKGROUND: An Advanced Care Planning (ACP) program of health decisions is the result of a
 process of reflection and relationship-building between the patient, their relatives and
 health professionals. It is based on respect for patients' autonomy, involving them in making
 decisions about their disease in a way that is shared between the medical team, the patient
 and their relatives. Up until now, the efficacy of an ACP has not been measured in the
 existing literature, and therefore it is unknown if these programs reach their goal.
 OBJETIVES: The main objective of our study is to evaluate the efficacy of an ACP program for
 decision-making in patients with advanced heart failure (HF) in comparison to usual follow up
 and care. This objective will be evaluated by the Patient Activation Measure test, which
 measures the participation and self-management of the patient in decision-making. Secondary
 objectives: to evaluate the effect of the program on quality of life, to know if the patients
 wishes expressed through the ACP program are fulfilled, to measure the impact of the program
 on patients' caregivers, to determine the satisfaction of patients included in the program
 and to evaluate the effect on quality of death. METHODS: randomized multicentre clinical
 trial at four hospitals in Madrid. Once they are included in the study, patients' allocation
 to groups (control vs intervention) will be made by alternative sampling. ACP will be applied
 to the intervention group, whereas in the Control Group usual follow-up will be carried out
 in HF units. All patients will fulfil questionnaires and tests related to the objectives of
 the study again after a 12-month follow-up period in order to gauge the effect of ACP in
 patients with advanced HF.
Inclusion Criteria:

 -  Patients with HF defined by Framingham diagnostic criteria.

 -  Stage C or D of the ACCF / AHA classification.

 -  Full capacity to decide.

 -  Signing of informed consent.

 Exclusion Criteria:

 -  Cognitive impairment, measured by Mini-Mental Status Examination (< 27).

 -  Presence of another disease other than HF that may severely affect the quality of
 life: stroke with significant residual deficit, end-stage renal failure, Child C
 cirrhosis, extreme obesity, haemoglobin <8 g / dl, advanced peripheral artery disease
 (stage III-IV), severe thyroid or adrenal disease, neoplastic with estimated survival
 of less than 2 years.

 -  Patients who do not sign the informed consent.