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

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

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)1335-1340
Number of pages6
JournalJournal of pain and symptom management
Issue number5
Publication statusPublished - May 2018


  • Terminal care
  • clinical decisions
  • heart failure
  • prognosis

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