The prevalence and incidence of heart failure (HF) has significantly increased in recent years, in part due to population ageing. It has become the leading cause for admission to Spanish hospitals in patients over 65 years, and currently accounts for 3% of all hospital admissions and 2.5% of the cost of healthcare [1]. While reduction of mortality and morbidity have been the primary objectives in most of HF studies, we must not forget that HF, in addition to increasing mortality, involves a drastic reduction in patients’ quality of life and leads to deterioration of their functional capacity. Taking into account that patients with HF are often elderly, the negative impact of HF on patients’ autonomy in healthcare decisions can be understood.

The Spanish legal framework clearly states both patients and healthcare professionals rights and obligations regarding the clinical relationship. Law 41/2002 regulating patient autonomy was enacted in 2002 [2]. In this Law—as well as in subsequent legal norms—it is specified that patients have the right to state their will in advance through Advance Directives [3, 4]. However, Advance Directives (AD) have little impact on clinical practice, not only in Spain but also in many other countries [5‐8]. The lack of impact on clinical practice of AD, as well as the common belief that they only concern patients with terminal illnesses, has led to the conclusion that decision making at the end of life must not depend exclusively on these written forms. These decisions should be centered on communication among doctors, patients and relatives during the end-of-life process [9‐11], according to a specific procedure named Advanced Care Planning (ACP) of health decisions. ACP is a structured approach that allows patients, relatives and physicians to discuss end-of-life decisions. ACP enables individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and health-care providers, and to record and review these preferences if appropriate [12]. There is evidence that ACP interventions can improve patient-related outcomes such as patient satisfaction with care, quality of communication and shared decision-making [13].

ACP programs for decision-making have been carried out in Spain in diseases like chronic kidney disease, [14, 15], but have not yet been applied to HF. Until now there have not been studies to determine if ACP programs are effective and, consequently, if they meet their objectives. Therefore it is our objective to carry out a Randomized Clinical Trial to evaluate the efficacy an ACP program for health decisions in patients with advanced HF. The aim of this article is to present our study protocol.

An ACP program involves planning decisions for patients who are at risk of losing the ability to decide. To do this, patients have to be adequately informed and supported by the healthcare team, so that they can establish their preferences regarding health. Possible future clinical scenarios must be foreseen so that the patients can express their wishes.

All these possible scenarios and the patient’s values must be known by their healthcare team and entered into their medical record, so as to ensure the patients’ wishes are respected if there is a situation in which they are unable to express their care preferences.

The characteristics of patients with advanced HF make them a model for designing ACP programs, given the high prevalence of this disease, the progressive increase in its incidence and it’s clinical characteristics: a low life expectancy in advanced phases and the ability to foresee future clinical scenarios on which is possible to plan decision-making [21]. Until now, the efficacy of this type of program has not been measured, so this Clinical Trial can provide relevant data for future ACP projects.