• Paul Taylor, Simon Crouch, Debra A Howell, Dawn W Dowding, and Miriam J Johnson.
• School of Health and Related Research, University of Sheffield, Sheffield, UK; St Luke's Hospice, Sheffield, UK. Electronic address: drpaulmtaylor@gmail.com.
• J Pain Symptom Manage. 2018 May 1; 55 (5): 1335-1340.

ContextRecognition 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.ObjectivesTo use routinely collected data to explore evidence for physiological change in the final two weeks of life in end-stage heart failure.MethodsThis 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.ResultsResults 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.ConclusionsDeteriorating 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.Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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