Background: The determination of prognosis in heart failure (HF) has focused primarily on the identification of potential biological and physiological markers and not on communication. High morbidity and mortality rates suggest that patients require prognostic information to assist in life planning. This study examined the preferences of both patients with HF and cardiologists for prognosis communication in the outpatient clinical setting, with the aim of guiding practitioners in undertaking prognosis conversations. Methods: Using qualitative descriptive techniques informed by a grounded theory approach, 32 patients with HF and 9 cardiologists from outpatient settings in Ontario, Canada were interviewed to identify convergent preferences for prognosis communication. Strategies to enhance methodological rigor were employed. Results: Individualized, context-specific prognosis communication between patients and cardiologists was preferred. Two main themes and ten related attributes were identified to describe convergent preferences; 1) Set the Stage for Prognosis Communication, and 2) Map the HF route. Attributes reflected the complex, dynamic, interactive and iterative nature of prognosis communication preferences. Conclusions: Prognosis communication occurs within a complex, adaptive healthcare system. While specific preferences exist, changing contextual elements within and outside of the system create conditions that require cardiologists to adjust their approach to individual patients. Patients with HF and cardiologists each have preferences that affect their willingness and ability to engage in dyadic HF-specific prognosis communication. Findings have relevance for the implementation of any efforts, including HF guidelines, aimed at improving prognosis communication. Our findings, informed by a complexity science approach, offer an innovative and robust alternative to traditional linear approaches to prognosis communication.

Helicopter EMS (HEMS) allows for patients to be quickly transported into regional cardiac centers, often to receive primary percutaneous coronary intervention (PCI). Since PCI is a time-critical therapy, it is important that patients get to primary PCI as quickly as possible. HEMS crews’ “on-scene” times for trauma patients have been extensively studied, and recent years have seen many efforts to minimize the time required to prepare patients for transport. There has been less attention to interfacility transport “scene times” for HEMS crews at referring hospitals; this includes stabilization times for preparing cardiac patients for loading onto aircraft for HEMS transport to primary PCI. In the absence of guiding evidence, system benchmarking and quality improvement are difficult. Therefore the current study was undertaken, to assess and describe the HEMS crew “on-scene” times or “patient stabilization times” (PSTs) at referring hospitals, for interfacility transported cardiac patients flown for primary PCI. Descriptive analysis identified a PST median of 19 minutes (interquartile range 15 - 24), and univariate analyses using Kruskal-Wallis testing found no association between prolonged PST and sending unit type (Emergency Department versus other), off-hours transports, or relatively frequent (at least monthly) use of HEMS (p for all comparisons > 0.64). Outlier PSTs, defined a priori as those exceeding the median by at least a half-hour, were found in 12% of all cases. These data could be useful as a starting point for system planning and benchmarking efforts in regionalized systems of acute cardiac care.