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

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 cardiopulmonary 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.