Abstract 2378: End of Life Preferences in Elderly Heart Failure Patients: To Live Better or Longer?
Background: It is generally assumed that elderly patients (pts) with severe chronic disease would prefer improved quality of life (QoL) rather than prolonged survival and that this would depend on the severity of underlying disease. However, there is little data in this regard, particularly in elderly pts with chronic heart failure (CHF).
Methods: In a multicenter, prospective trial, 622 pts aged > 60 years with a hospital discharge diagnosis of CHF within the preceding year, dyspnoea NYHA ≥ II, and a BNP value ≥ 2x upper limit of normal were included. Besides clinical characteristics, end-of-life (EoL) preferences using a time-trade-off (TTO) instrument and QoL questionnaire (Minnesota living with CHF; geriatric depression score) were assessed. For TTO, pts were asked if they were willing to accept a shorter life span for living without any symptoms. Pts were also asked if they would want to be resuscitated if this would be required. Predictors of EoL preferences were evaluated.
Results: Pts were 79 ± 8 (60 –97) years of age, 59% male with a mean LVEF of 35 ± 13%. Main causes of CHF were coronary (53%) and hypertensive (28%) heart disease. Of the 622 pts, 556 (89%) replied to the TTO question, of which 74% were not willing to trade survival time for improved QoL. Willingness to trade time for QoL was higher in pts with NYHA ≥ III (33 vs 21%, p = .001), lower haemoglobin (12.7 ± 1.9 vs 13.2 ± 1.8g/dl, p = .002), higher depression score (5.1 ± 3.3 vs 4.1 ± 3.0, p = .003), and who were living alone (34 vs 22%, p = .002; all independent predictors). Age ≥ 75 years, female gender, LVEF > 45% and osteoporosis were additional univariate predictors of this willingness. Of 603 (97%) expressing their resuscitation preference, 51% would have wanted resuscitation, 39% not, and 10% were undetermined. No resuscitation was preferred by older pts, women, those living alone and with a higher depression score in multivariate analysis. All other variables were not related to this preference or only in univariate analysis (hemoglobin, history of stroke, arthritis).
Conclusions: The majority of elderly CHF pts prefer longevity over QoL and half would want to be resuscitated. EoL preferences were mainly determined by symptoms, social status, depression, and to certain degree also by age and female gender.