• Gwen M Bernacki, Cara L McDermott, Daniel D Matlock, Ann M O'Hare, Lyndia Brumback, Nisha Bansal, James N Kirkpatrick, Ruth A Engelberg, and Jared Randall Curtis.
• Cambia Palliative Care Center of Excellence, University of Washington (G.M.B., C.L.M., J.R.C.), Seattle, WA; Division of Cardiology, Department of Medicine, University of Washington (G.M.B., J.N.K.), Seattle, WA; Hospital and Specialty Medicine Service, VA Puget Sound Health Care System (G.M.B., A.M.H. ), Seattle, WA. Electronic address: bernacki@uw.edu.
• J Pain Symptom Manage. 2022 Feb 1; 63 (2): e168e175e168-e175.

ContextHeart failure (HF) and chronic kidney disease (CKD) are associated with high morbidity and mortality, especially in combination, yet little is known about the impact of these conditions together on end-of-life care.ObjectivesCompare end-of-life care and advance care planning (ACP) documentation among patients with both HF and CKD to those with either condition.MethodsWe conducted a retrospective analysis of deceased patients (2010-2017) with HF and CKD (n = 1673), HF without CKD (n = 2671), and CKD without HF (n = 1706), excluding patients with cancer or dementia. We compared hospitalizations and intensive care unit (ICU) admissions in the last 30 days of life, hospital deaths, and ACP documentation >30 days before death.Results39% of patients with HF and CKD were hospitalized and 33% were admitted to the ICU in the last 30 days vs. 30% and 28%, respectively, for HF, and 26% and 23% for CKD. Compared to patients with both conditions, those with only 1 were less likely to be admitted to the hospital [HF: adjusted odds ratio (aOR) 0.72, 95%CI 0.63-0.83; CKD: aOR 0.63, 95%CI 0.53-0.75] and ICU (HF: aOR 0.83, 95%CI 0.71-0.94; CKD: aOR 0.68, 95%CI 0.56-0.80) and less likely to have ACP documentation (aOR 0.53, 95%CI 0.47-0.61 and aOR 0.70, 95%CI 0.60-0.81).ConclusionsDecedents with both HF and CKD had more ACP documentation and received more intensive end-of-life care than those with only 1 condition. These findings suggest that patients with co-existing HF and CKD may benefit from interventions to ensure care received aligns with their goals.Published by Elsevier Inc.

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