Advanced care planning compared with usual care for patients with heart failure

Patient or population: heart failure patients with or without their surrogate decision‐makers/carers

Settings: in‐patient and out‐patient hospitals and clinics

Intervention: advanced care planning

Comparison: usual care

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of Participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Usual care

ACP

Concordance between participants' preferences and end‐of‐life care (yes/no)

[value] per 1000

[value] per 1000
([value] to [value])

RR [value] ([value] to [value])

[value]
([value])

⊕⊝⊝⊝
very low

⊕⊕⊝⊝
low

⊕⊕⊕⊝
moderate

⊕⊕⊕⊕
high

Participants' quality of life

The mean quality of life score ranged across control groups from [value][measure]

The mean quality of life score in the intervention groups was
[value] [lower/higher]
[(value to value lower/higher)]

MD [value] ([value] to [value]) or SMD [value] ([value] to [value])

[value]
([value])

⊕⊝⊝⊝
very low

⊕⊕⊝⊝
low

⊕⊕⊕⊝
moderate

⊕⊕⊕⊕
high

Participants' satisfaction with care/treatment (yes/no)

[value] per 1000

[value] per 1000
([value] to [value])

RR [value] ([value] to [value])

[value]
([value])

⊕⊝⊝⊝
very low

⊕⊕⊝⊝
low

⊕⊕⊕⊝
moderate

⊕⊕⊕⊕
high

Completion of documentation by medical staff regarding discussions with participants about ACP processes (yes/no)

[value] per 1000

[value] per 1000
([value] to [value])

RR [value] ([value] to [value])

[value]
([value])

⊕⊝⊝⊝
very low

⊕⊕⊝⊝
low

⊕⊕⊕⊝
moderate

⊕⊕⊕⊕
high

Participants' depressive state

The mean quality of life score ranged across control groups from [value][measure]

The mean quality of life score in the intervention groups was
[value] [lower/higher]
[(value to value lower/higher)]

MD [value] ([value] to [value]) or SMD [value] ([value] to [value])

[value]
([value])

⊕⊝⊝⊝
very low

⊕⊕⊝⊝
low

⊕⊕⊕⊝
moderate

⊕⊕⊕⊕
high

Caregivers' satisfaction with care/treatment (yes/no)

[value] per 1000

[value] per 1000
([value] to [value])

RR [value] ([value] to [value])

[value]
([value])

⊕⊝⊝⊝
very low

⊕⊕⊝⊝
low

⊕⊕⊕⊝
moderate

⊕⊕⊕⊕
high

Quality of communication

The mean quality of communication domain score ranged across control groups from [value][measure]

The mean quality of communication domain score in the intervention groups was [value] [lower/higher]
[(value to value lower/higher)]

MD [value] ([value] to [value]) or SMD [value] ([value] to [value])

[value]
([value])

⊕⊝⊝⊝
very low

⊕⊕⊝⊝
low

⊕⊕⊕⊝
moderate

⊕⊕⊕⊕
high

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
ACP: advanced care planning; CI: confidence interval; MD: mean difference; RR: risk ratio; SMD: standardised mean difference

GRADE Working Group grades of evidence
High‐quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate‐quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low‐quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low‐quality: we are very uncertain about the estimate.