• Lucy A Kernick, Karen J Hogg, Yvonne Millerick, Murtagh Fliss E M FEM 1 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK., Ayse Djahit, and Miriam Johnson.
• 1 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
• Palliat Med. 2018 Dec 1; 32 (10): 1539-1551.

BackgroundPeople with advanced heart failure have repeated hospital admissions. Advance care planning can support patient preferences, but studies in people with heart failure have not been assessed.AimTo evaluate the literature regarding advance care planning in heart failure.DesignSystematic review and narrative analysis (PROSPERO CRD42017059190).Data SourcesElectronic databases were searched (1990 to 23 March 2017): MEDLINE(R), Cochrane Library, CINAHL and Scopus. Four journals were hand searched. Two independent researchers screened against eligibility criteria. One reviewer extracted all data and a sample by a second. Quality was assessed by Cochrane Risk of Bias or the Critical Appraisal Skills Programme Tool for Cohort Studies.ResultsOut of the 1713 articles, 8 were included representing 14,357 participants from in/outpatient settings from five countries. Two randomised controlled trials and one observational study assessed planning as part of a specialist palliative care intervention; one randomised controlled trial assessed planning in addition to usual cardiology care; one randomised controlled trial and one observational study assessed planning in an integrated cardiology-palliative care model; one observational study assessed evidence of planning (advance directive) as part of usual care and one observational study was a secondary analysis of trial participants coded Do Not Attempt Cardiopulmonary Resuscitation. Advance care planning: (1) reduced hospitalisation (5/7 studies); (2) increased referral/use of palliative services (4/4 studies); and (3) supported deaths in the patient-preferred place (2/2 studies).ConclusionAdvance care planning as part of specialist palliative care reduces hospitalisation. Preliminary studies of planning integrated into generic care, accessing specialist palliative care support if needed, are promising.

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