心不全で入院した患者の終末期に関する希望：PREFICTER研究

Clinical practice guidelines for heart failure (HF) recommend advance care planning and assessment of patients' end-of-life preferences. However, very few studies have captured these preferences or their relationship with prognosis.

Observational, multicenter, survey-style study of patients aged 75 or older admitted for HF to internal medicine department of 60 Spanish hospitals. Patients were followed for 6 months and mortality, emergency room visits and readmissions were recorded.

A total of 673 patients were included. The median age was 86 years, and they had significant comorbidity, frailty (59%), and a predominance of HF with preserved left ventricular ejection fraction (75%). A total of 92% of patients prioritized quality of life over living longer. A total of 9% had spoken with their physician about cardiopulmonary resuscitation; 29% did not want cardiopulmonary resuscitation, and 37% had not yet decided. About 15% of patients were considering requesting euthanasia. Adequate symptom control, particularly dyspnea and pain, was the patients' major priority. None of the end-of-life preferences expressed by patients were shown to be an independent prognostic factor at 6 months of follow-up.

Elderly patients with multiple pathologies admitted for HF prioritize quality of life and symptom control over living longer. Advance care planning for them should be systematic and proactive. Full English text available from: www.revespcardiol.org/en.