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Heart Failure in the Oldest Old: A Qualitative Case Study on Patients` Perception of and Communication about Illness and Prognosis

Katharina Klindtworth, Martina Pestinger, Peter Oster, Klaus Hager and Nils Schneider

Heart failure has a poor long-term prognosis and causes high burden of disease. The aim of this study was to gain an in-depth understanding how elderly patients with advanced heart failure perceive and communicate their illness. We carried out a longitudinal case study of two patients (female, 86 and 95 years old, heart failure NYHA III/IV, different social settings) with a total of eight qualitative interviews, covering a period of nine months. The interviews were analyzed using both coding and a narrative approach. Both patients were poorly informed about heart failure and its prognosis. The patients` major concerns were centered more on organizational issues than on emotional aspects concerning death and dying. Summarized, open discussion of end-of-life issues is difficult in elderly patients with advanced heart failure. Advance care planning could be an appropriate strategy to improve communication and delivery of health and social care.