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 d ecision of whether or not to start cardiopulmonary resuscitation (CPR) in t he 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 c ardiac arrest, form their attitudes towards CPR and to what extent they wan t to be involved in making decisions concerning CPR. Design. This study employs a combined qualitative and quantitative intervie w concerning patients' knowledge about CPR, their experiences and preferenc es regarding involvement in making decisions concerning CPR, and their will ingness 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 chr onic 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 abi lity to judge if CPR was to be regarded as a potentially beneficial interve ntion or as an unmotivated one. Nevertheless, the patients welcomed the opp ortunity to take part in the decision-making process. Conclusion. In order to make ethically justified decisions, physicians shou ld consider bringing up the question of CPR with patients suffering from he art failure at the point in time where the progressive disease gives rise t o more severe symptoms, corresponding to NYHA classes IIIb-IV. In earlier s tages of the disease, one can assume that the patient will opt for CPR unle ss he or she demonstrates a negative attitude towards life.