Background: Religious beliefs may influence decision-making about end-of-life care among patients with Chronic Heart Failure (CHF) and may change towards the end-of-life. Data in CHF are scarce. Aims of this longitudinal observational study were: to explore whether preferences for life-sustaining treatments and end-of-life care are influenced by religious beliefs among patients with CHF; and to explore whether religious beliefs change towards the end-of-life.
Methods: This study included 427 patients with CHF of the TIME-CHF study (69% of the original sample; 62% male; mean age 76.6 (7.5) years; 62% NHYA class III). Confession, strength of religious beliefs (Religion Questionnaire), preferences for CPR, and willingness to trade survival time for excellent health were assessed (Time Trade-Off tool). The relationship between religious beliefs and preferences for CPR and willingness to trade survival time at baseline was explored. In addition, changes in religious beliefs between baseline and 12 months were explored among patients who died between 12 and 18 months.
Results: 47% were Catholic, 42% Protestant, 5% other and 6% atheist. Atheist patients more often preferred ‘Do Not Resuscitate’ (DNR) than Catholic patients (56% vs 32%, respectively, p = 0.03). Patients with strong religious beliefs as assessed with the Religion Questionnaire were less likely to prefer DNR than patients without religious beliefs (p < 0.05). There was no relationship with willingness to trade survival time (p > 0.05). The belief in afterlife increased among patients who died between 12 and 18 months (p = 0.04), while feeling supported by religion tended to decrease at the end of life (p = 0.07).
Conclusions: CHF Patients with strong religious beliefs are less likely to prefer DNR. Religious beliefs may change towards the end-of-life. Therefore, exploring religious beliefs and the influence on preferences for life-sustaining treatments as part of advance care planning seems to be important.