Should cardiopulmonary resuscitation be performed on patients with heart failure? The role of the patient in the decision-making process.

OBJECTIVES: There is an ongoing debate about patients' involvement in the decision of whether or not to start, cardiopulmonary resuscitation (CPR) in the case of cardiac arrest. The objective here is to analyse on what grounds patients with heart failure, who run a relatively high risk of suffering cardiac arrest, form their attitudes towards CPR and to what extent they want to be involved in making decisions concerning CPR.
DESIGN: This study employs a combined qualitative and quantitative interview concerning patients' knowledge about CPR, their experiences and preferences regarding involvement in making decisions concerning CPR, and their willingness to undergo CPR.
SETTING: The study was performed at the Department of Cardiology, Sahlgrens University Hospital, Gothenburg.
SUBJECTS: The subjects involved were 40 patients with various stages of chronic heart failure.
RESULTS: Many of the interviewees lacked fundamental knowledge of CPR. The majority of the patients opted for CPR no matter how small their chances of survival were. The issue had not earlier engaged their thoughts, even less been discussed with physicians. The patients relied on the physician's ability to judge if CPR was to be regarded as a potentially beneficial intervention or as an unmotivated one. Nevertheless, the patients welcomed the opportunity to take part in the decision-making process.
CONCLUSION: In order to make ethically justified decisions, physicians should consider bringing up the question of CPR with patients suffering from heart failure at the point in time where the progressive disease gives rise to more severe symptoms, corresponding to NYHA classes IIIb-IV. In earlier stages of the disease, one can assume that the patient will opt for CPR unless he or she demonstrates a negative attitude towards life.