End-of-life preferences of elderly patients with chronic heart failure
End-of-life preferences of elderly patients with chronic heart failure
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DOI：
10.1093/eurheartj/ehr404
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发表时间：
2012-03-01
影响因子：
39.3
通讯作者：
Rickli, Hans
中科院分区：
文献类型：
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作者：
Brunner-La Rocca, Hans-Peter;Rickenbacher, Peter;Rickli, Hans
老年心力衰竭（HF）患者被认为更喜欢改善生活质量而不是长寿，但缺乏足够的数据。因此，我们评估了用生存时间换取生活质量（QoL）的意愿和对复苏的偏好。在基线和12个月和18个月后，622名年龄为epsilon 60岁（778岁，74名nyha级epsilon III）的HF患者参加了老年充血性心力衰竭患者强化与标准药物治疗的试验，通过回答权衡问题（愿意接受更短的寿命以换取无症状的生活）和必要时的复苏偏好，对临终偏好进行了前瞻性评估。555名患者（89名）回答了时间权衡问题，其中74名患者不愿意为了改善生活质量而牺牲生存时间。这一比例随着时间的推移而增加（第12个月：85，第18个月：87，P 0.001）。在多变量分析中，交易生存时间的意愿随年龄、女性、降低的杜克活动状态指数、老年抑郁评分、痛风史、运动不耐受、便秘和水肿而增加，但即使结合这些变量也不能得出可靠的预测。603例（97例）患者表达复苏偏好，51例希望复苏，39例不希望复苏，10例未决定，随时间变化不大。在430例患者中，已知复苏指令；他们有32次与患者的偏好不同。临终偏好与18个月的结果无关。老年心衰患者愿意解决他们的临终偏好。大多数人更喜欢长寿而不是生活质量，一半的人希望在必要时进行复苏。对个人偏好的预测是不准确的。试验注册：isrctn.org标识符：ISRCTN43596477。
Elderly heart failure (HF) patients are assumed to prefer improved quality of life over longevity, but sufficient data are lacking. Therefore, we assessed the willingness to trade survival time for quality-of-life (QoL) and the preferences for resuscitation.At baseline and after 12 and 18 months, 622 HF patients aged epsilon 60 years (77 8 years, 74 NYHA-class epsilon III) participating in the Trial of Intensified vs. standard Medical therapy in Elderly patients with Congestive Heart Failure had prospective evaluation of end-of-life preferences by answering trade-off questions (willingness to accept a shorter life span in return for living without symptoms) and preferences for resuscitation if necessary. The time trade-off question was answered by 555 patients (89), 74 of whom were not willing to trade survival time for improved QoL. This proportion increased over time (Month 12: 85, Month 18: 87, P 0.001). In multivariable analysis, willingness to trade survival time increased with age, female sex, a reduced Duke Activity Status Index, Geriatric Depression Score, and history of gout, exercise intolerance, constipation and oedema, but even combining these variables did not result in reliable prediction. Of 603 (97) patients expressing their resuscitation preference, 51 wished resuscitation, 39 did not, and 10 were undecided, with little changes over time. In 430 patients resuscitation orders were known; they differed from patients preferences 32 of the time. End-of-life preferences were not correlated to 18-month outcome.Elderly HF patients are willing to address their end-of-life preferences. The majority prefers longevity over QoL and half wished resuscitation if necessary. Prediction of individual preferences was inaccurate. Trial Registration: isrctn.org Identifier: ISRCTN43596477.