Associated factors of terminal decision making in hospitalized elderly patients with heart failure: A single-center retrospective study

Abstract Aims This study aims to examine the associated factors of end-of-life decision-making in elderly patients with heart failure. Methods and results Retrospective data from 2,320 inpatients aged ≥60 years with heart failure at a tertiary hospital in Sichuan, China were analyzed using chi-square tests, Mann-Whitney U tests, and logistic regression. Results showed that 60.9% (1,413 cases) chose active treatment, while 39.1% (907 cases) opted for non-active treatment. Key factors associated with non-active treatment included: critical illness notice signed by non-spousal/non-offspring relatives (P=0.006, OR=1.444), low medical reimbursement ratio (≤50% vs. 50%; P=0.001, OR=1.412), absence of a caregiver (P0.001, OR=1.476), and moderate pain (P=0.012, OR=1.446). Severe pain tended to be associated with non-active treatment, though the association did not reach statistical significance (P=0.062, OR=1.573). In contrast, factors associated with a reduced probability of non-active treatment were a greater number of indwelling tubes (3–4 tubes vs. 0–2 tubes: P=0.001, OR=0.677; 4 tubes vs. 0–2 tubes: P0.001, OR=0.481) and an earlier admission period (2008–2017 vs. 2018–2024; P=0.017, OR=0.808). Conclusion End-of-life clinical decisions in elderly patients with heart failure are shaped by multiple associated factors, including critical illness notice signatory, pain severity, reimbursement ratio, caregiver presence, admission year, and the number of indwelling tubes. Clarifying these factors may help to understand decision-making preferences and optimize end-of-life care plans.