Trajectory of Illness for Patients with Congestive Heart Failure

Background and Objective: This study describes progression to death for patients with congestive heart failure (CHF). Methods: We used SAS procedure Proc Traj to fit a semiparametric model to longitudinal data on prognosis of patients with CHF in the 12 months prior to death. Data were collected on 744 patients with CHF in 2010 at Bay Pines VA Healthcare System; 386 subjects had sufficient data points (minimum of five encounters) to trace their risk in 12 months prior to death. The prognosis of the patient was calculated using the comorbidities of the patient. Results: Unexpected death occurred in 20.5% of patients; all remaining patients had a gradual progression toward death. For 13.3% of patients, progression toward death started 12 months prior to death. For 29.9% of patients, increased risk started at 6 months prior to death. For 36.3% of patients, it started 3 months prior to death. One month prior to death, 79.5% of the patients had a more than 97% chance of mortality. It may be possible to use progression toward death over 3 consecutive months as a predictor of need for hospice consultation. Conclusions: Five typical illness trajectories have been described for patients with progressive heart failure. The needs of patients and their caregivers are likely to vary according to the trajectory patients are following. Contrary to reports in the literature about unexpected death in patients with CHF, the majority of decedents in our study had a predictable and gradual progression toward death. Recognizing these trajectories may help clinicians implement an appropriate plan to meet the needs of patients and their caregivers.