Change in Physiological Variables in the Last Two Weeks of Life: An Observational Study of Hospitalized Adults With Heart Failure

Taylor, Paul; Crouch, Simon; Howell, Debra A.; Dowding, Dawn W.; Johnson, Miriam J.

Abstract

© 2018 American Academy of Hospice and Palliative Medicine Context: Recognition of dying is a difficult task in end-stage heart failure, yet it remains an important clinical skill in providing good palliative care to these patients. Objectives: To use routinely collected data to explore evidence for physiological change in the final two weeks of life in end-stage heart failure. Methods: This was a retrospective cohort study of routinely collected data from hospital inpatients dying as a result of heart failure during a one-year period in a U.K. hospital. Data were analyzed using descriptive techniques and multilevel modeling. Results: Results were obtained on 81 patients. Respiratory function (evidenced by falling oxygen saturation and rising respiratory rate) deteriorated by a clinically significant amount in the final two weeks of life (P < 0.001). Renal function (evidenced by rising serum urea and creatinine) also demonstrated a clinically significant deterioration over the same period (P < 0.001 and P = 0.005, respectively). Serum albumin fell over a period of months (P < 0.001). Heart rate and blood pressure did not demonstrate clinically significant change over the same period. Conclusions: Deteriorating respiratory and renal function may indicate imminent dying in heart failure. A fall in serum albumin may signify poor prognosis over a timescale of weeks to months. Conversely, hemodynamic parameters may remain relatively stable in the final days of life and should not be reassuring in end-stage heart failure patients.

Citation

Taylor, P., Crouch, S., Howell, D. A., Dowding, D. W., & Johnson, M. J. (2018). Change in Physiological Variables in the Last Two Weeks of Life: An Observational Study of Hospitalized Adults With Heart Failure. Journal of pain and symptom management, 55(5), 1335-1340. https://doi.org/10.1016/j.jpainsymman.2018.01.006

• Journal Article Type: Article
• Acceptance Date: Jan 10, 2018
• Online Publication Date: Jan 21, 2018
• Publication Date: May 1, 2018
• Deposit Date: May 3, 2022
• Journal: Journal of Pain and Symptom Management
• Print ISSN: 0885-3924
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 55
• Issue: 5
• Pages: 1335-1340
• DOI: https://doi.org/10.1016/j.jpainsymman.2018.01.006
• Keywords: Terminal care; Heart failure; Prognosis; Clinical decisions
• Public URL: https://hull-repository.worktribe.com/output/3594700