Communication and choice in dying from heart disease.

In heart disease palliative care has received less attention than in cancer. In the Regional Study of Care for the Dying, carers of a random sample of deaths in 20 English health districts were interviewed about 10 months after the death. There were 675 respondents for patients dying with heart disease, and we report data on 600 deaths that were not sudden. 54% of patients died in hospital, 30% in their own home, 11% in a nursing or residential home, and 4% in other places. Half the patients were said to have known, or probably known, that they were likely to die; of these, 82% were said to have worked this out for themselves rather than been told by a doctor or nurse. More than one-third of patients (39%) died without an informal carer present. Respondents said that a quarter of the patients had wanted to die earlier: this desire was associated with older age and the number and severity of symptoms. The study suggests the need for health services to give greater attention to palliative care for patients dying with heart disease.