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QJM 2004 97(12):803-808; doi:10.1093/qjmed/hch135
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QJM vol. 97 no. 12 © Association of Physicians 2004; all rights reserved.

End-of-life preferences in elderly patients admitted for heart failure

F. Formiga, D. Chivite, C. Ortega, S. Casas, J.M. Ramón1 and R. Pujol

From the Geriatric Unit, Internal Medicine Service, and 1Preventive Medicine and Epidemiology Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain

Received 2 April 2004 and in revised form 6 September 2004

Background: Heart failure is increasing in prevalence and incidence, with considerable mortality among the elderly.

Aim: To determine preferences concerning cardiopulmonary-resuscitation (CPR) and end-of-life care in elderly patients hospitalized for heart failure.

Design: Prospective interview-based survey.

Methods: Patients >64 years old admitted for acute heart failure were interviewed to address their preferences regarding end-of-life care and cardio-pulmonary resuscitation (CPR) when facing the last stages of their disease.

Results: We interviewed 80 patients (mean age 79 years; 58% women). Thirty-two (40%) expressed a wish not to have CPR. Only two had previously discussed their CPR preferences with their physicians. When recovery from the illness was considered unlikely, 40 (50%) participants preferred to receive treatment at home, 32 (40%) preferred in-hospital management, and 8 (10%) were unsure. Thirty-three patients (41%) expressed a desire for spiritual support, 38 (48%) said not and the remaining 9 (11%) were indifferent.

Discussion: Advance planning of end-of-life procedures and doctor–patient communication regarding these items remains poor and must be improved.

Address correspondence to Dr F. Formiga, Geriatric Unit – Internal Medicine Service, Hospital Universitari de Bellvitge ‘Princeps d'Espanya’, L'Hospitalet de Llobregat 08907, Barcelona, Spain. e-mail: fformiga{at}csub.scs.es


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