1SRH Wald-Klinikum Gera GmbH Kardiologie und Internistische Intensivmedizin Gera, Deutschland; 2SRH Waldklinikum Gera Klinik für Anästhesiologie und Intensivtherapie Gera, Deutschland
In many people with acutely life-threatening illnesses, the will to undergo treatment is not known with sufficient precision. It is often unclear whether the person concerned would have consented to life-sustaining measures or would have preferred to die with palliative care. This applies in particular to the vulnerable group of elderly, chronically ill/fragile people. It is not uncommon for people to reject the risks/burdens of medical treatment, even if there is a chance of success. On the other hand, there are many people who fight to continue living, even if this can be associated with great burdens and the outcome is rather uncertain.
The aim of the study is to determine the willingness or refusal of cardiology patients to deal with treatment wishes/preferences in acute emergencies, incapacity to consent of unclear duration (e.g. in the context of intensive care unit (ICU) treatment) or permanent incapacity to consent (vegetative state) during an inpatient stay.Methods
Prospective, questionnaire-based cross-sectional study including Hospital Anxiety and Depression Scale (HADS) and assessment of quality of life using the 12-item Short Form Health Survey (SF-12) on normal cardiology wards.
A total of 455 patients were surveyed (60% males). 75% of the patients had moderate-to-severe comorbidities according to CCI. 238 (52.3%) patients already had a living will. 70 % of patients without a living will plan to so in the future. 74% of the patients found the survey topic important. The average age was 71.2 years ± 12.9, with the female population being significantly older (p<0,0001; mean 72.9 ± 13.1 for females; 70.1 ± 12.8, for males). We found a significant correlation between age and finding the survey topic of importance (p<0,05) as more patients with age over 73 years found the survey meaningful (52.27% vs 47.73%). Additionally, patients with age over 73 years reported significantly higher anxiety (p<0.0001; mean >73: 9.9 ± 2.3; ≤73: 3.8 ± 2.1) as well as depression (p<0.0001; mean age >73: 9.4 ± 3.9; ≤73: 4.4 ± 3.2). The female population also reported significantly higher anxiety/depression levels in the overall HADS score (p<0.05; mean 14.3 ± 7.4 for females; 12.8 ± 7.9 for males), as well as in anxiety score (p<0.01; mean 7.2 ± 3.7 for females; 6.3 ± 3.9 for males). Moreover, a significantly worse physical health was reported by females in the SF-12 survey (p<0.01; mean 39.1 ± 21.6 for females; 42.9 ± 22.5 for males). 45% of patients can imagine a situation in which life-sustaining measures/ intensive care (ITS) treatment is not the best option. In case of organ failure or life-threatening disease 50.1 % of the respondents wished for ITS treatment, however only 8% still want this if ITS treatment could result in permanent damage/need for care. Also here we found significant correlation between gender and the wish for an ITS treatment (p<0.001) as more males (35.3%) expressed this wish in comparison to females (14.7%).
Conclusion
A high percentage of normal inpatients in cardiology are willing to discuss treatment wishes/preferences in the event of acute emergencies or incapacity to give consent of unclear duration. Life-sustaining measures/ITS treatment is often not preferred by the majority of older patients.