Change in physiological variables in the last 2 weeks of life : an observational study of hospitalized adults with heart failure

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TAYLOR, Paul | CROUCH, Simon | HOWELL, Debra A. | DOWDING, Dawn W. | JOHNSON, Miriam J.

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 in-patients dying as a result of heart failure during a 1-year period in a UK hospital. Data were analysed using descriptive techniques and multilevel modelling. 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 time 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 time 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, haemodynamic parameters may remain relatively stable in the final days of life, and should not be reassuring in end-stage heart failure patients.

http://dx.doi.org/10.1016/j.jpainsymman.2018.01.006

Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT»

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