Dying trajectories in heart failure

Gott, Merryn
Barnes, Sarah
Parker, Chris
Seamark, David
Gariballa, Salah
Small, Neil

Sheffield Institute for Studies on Ageing, University of Sheffield, Sheffield (Gott) (Barnes)
Nottingham Primary Care Research Partnership, Sheila Payne Lancaster University (Parker)
Peninsula Medical School, University of Exeter (Seamark)
Faculty of Medicine, UAE University (Gariballa)
School of Health Studies, University of Bradford (Small)

Address for correspondence: Sarah Barnes, Sheffield Institute for Studies on Ageing, University of Sheffield, Elmfield, Northumberland Road, Sheffield, S10 2TU, UK. E-mail: [email protected]

Palliative Medicine 21(2):p 95-99, March 2007.

Objectives

To explore dying trajectories in heart failure.

Design

Prospective, longitudinal study.

Setting

Sixteen GP surgeries in four demographically contrasting areas of the UK.

Participants

A total of 27 heart failure patients, > 60 years of age, who completed questionnaires for at least five time-points before death. Main outcome measures: Kansas City Cardiomyopathy Questionnaire Physical Limitation Scale.

Results

No ‘typical’ dying trajectory could be identified, and only a minority of patients conformed to the theoretical trajectory of dying in heart failure.

Conclusions

This study provides the first prospective data regarding physical decline prior to death in heart failure. Findings challenge current efforts to plan and deliver palliative care services on the basis of the theoretical heart failure dying trajectory.