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Background: Heart failure (HF) is common among people aging with HIV (PWH) and without HIV (PWoH). Despite the poor prognosis for HF, advance directives (AD) completion is low but has not been compared among PWH and PWoH., Objectives: Determine the prevalence and predictors of AD screening among PWH and PWoH with incident HF., Methods: We included Veterans with an incident HF diagnosis code from 2013-2018 in the Veterans Aging Cohort Study (VACS) without prior AD screening. Health records were reviewed for AD screening note titles within -30 days to 1-year post-HF diagnosis. Analyses were stratified by HIV status. Trends in annual AD screening were evaluated with the Cochran-Mantel-Haenszel test. The associations of AD screening with demographics, disease severity (Charlson Comorbidity Index, VACS 2.0 Index), and healthcare encounters (cardiology, palliative care, hospitalization) were evaluated with Cox proportional hazards regression., Results: HF was diagnosed in 4516 Veterans (28.2% PWH, 71.8% PWoH). Annual AD screening rates increased in both groups (P trend <0.0001) and aggregate rates were higher among PWH than PWoH (53.5% vs. 48.2%, p=.001). In both groups, the likelihood of AD screening increased with greater disease severity, palliative care contact, and hospitalization (HR range=1.04-3.32, all p≤.02) but not with cardiology contact (p≥.53)., Conclusions: AD screening rates after incident HF remain suboptimal but increased over time and were higher in PWH. Future quality improvement and implementation efforts should aim for universal AD screening with incident HF diagnosis, initiated by providers skilled in discussing AD, including in the cardiology subspecialty setting., Competing Interests: Declaration of Competing Interest All authors report no conflicts of interest., (Published by Elsevier Inc.)

Background: Palliative care consultation (PCC) is recommended for older adults hospitalized with cardiopulmonary conditions, but frequently is reserved for patients with malignant conditions and those with advanced age., Objectives: To compare age-adjusted PCC trends and the relationship between increasing age and PCC among older adults with cardiopulmonary and malignant conditions., Methods: Observational analysis of patients age ≥ 65 years, stratified by age and cardiopulmonary (heart failure, chronic obstructive pulmonary disease) vs. malignant (lung and gastrointestinal) conditions. Age-adjusted PCC trends over time and compound annual growth rates (CAGR) were compared., Results: Discharges with cardiopulmonary vs. malignant conditions were older, more likely to be female, and white. Relative to malignant conditions, discharges with cardiopulmonary conditions had lower age-adjusted PCC rates but higher CAGRS. Increasing age was associated with PCC in both groups but had a stronger effect among cardiopulmonary conditions., Conclusions: Older adults with cardiopulmonary conditions experienced lower rates of PCC, but higher rates of growth over time relative to those with malignant conditions., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)