Background The Mental Capacity Act (MCA) came into force in England in 2007 to foster surrogate decision making, considered particularly relevant to advance care planning for those at the end of life. This study examined the impact of the MCA on the place of death(PoD) for heart failure(HF) patients sometimes affected by the loss of capacity.
Methods A national population-based retrospective cohort study of death registry data(DRD) in England, 2001–2016. All patients dying from HF (ICD-10: I50) were included. Capacity status designation was based on documentation of dementia (ICD-10: G30, F01, F03) as a comorbidity on DRD. Using binomial regression analysis, we compared PoD of HF decedents with and without comorbid dementia before and after MCA enactment.
Results 113,773 HF patients were included of whom 7,473 (6.5%) had dementia, these tending to be older, female, and with more comorbidities. 66% and 19% of HF patients with capacity died in the hospital or care home, respectively, the two commonest PoDs; in contrast, corresponding figures for those without capacity were 49% and 43%. Hospice as a PoD was rare (≤0.5%) in both groups. Over the above period encompassing MCA implementation, PoD for HF patients with capacity shifted from hospital to home or care home (adjusted prevalence ratio (APR): 1.024[95% CI: 1.021–1.026]; p<0.001); this trend less evident in those lacking capacity (APR: 0.995[0.981- 1.010]; p=0.51).
Conclusions Our analysis suggests a limited impact of the MCA on PoD for HF patients lacking capacity, perhaps reflecting greater complexity of care required of that clinical cohort.
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