Welcome to InCirculation.net
InCirculation.net is a professional cardiovascular resource intended for a global audience of specialists, generalists, researchers, and other healthcare professionals
Cardiovascular news provides daily news updates to help you stay informed.
Elderly HF patients have many thoughts about death
27 June 2008
Medwire News: Elderly patients with heart failure (HF) report many varying thoughts about death, with some regarding it as a natural relief from suffering and others feeling afraid of pain and a loss of independence and dignity, research reveals.
The authors say the findings underline the need to address "existential and end-of-life care issues" before elderly patients' HF becomes too advanced.
Anna Strömberg (Linköping University Hospital, Sweden) and Tiny Jaarsma (University of Groningen, The Netherlands) explored thoughts about death and perceived health status in 145 patients with New York Heart Association class II-IV HF, who were aged an average of 70 years.
Patients were followed-up during a 6-month period after hospitalization due to deterioration in their condition.
The researchers used the EuroQol-5D questionnaire, a generic single index defining health in the five dimensions of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, to determine patients' health status.
They also asked two questions on thoughts about death, the first a multiple choice question addressing fear of dying, and the second an open question inviting patients to freely write down their thoughts about death.
At baseline, 16% of the patients were afraid of dying compared with 13% of patients at 6 months. Few patients reported being severely afraid of dying, and fear of death did not change significantly over time, showing a strong correlation between baseline and 6-month measures.
Of the EuroQol-5D dimensions, only anxiety/depression was significantly associated with fear of death both at baseline and 6 months, with odds ratios of 2.49 (p<0.03) and 6.46 (p<0.001), respectively.
Analysis of the open-ended question showed two-thirds of patients expressed in various ways that they often thought about death.
The thoughts of death fell into five main categories, namely death as a natural part of life, death as a relief from symptoms, death as fearful, arrangements for time after death, and a wish to extend life.
"Elderly patients with HF have a lot of thoughts about death and this needs to be recognized in clinical practice," Stromberg and Jaarsma conclude in the European Journal of Heart Failure.
