Clinical practice guidelines for heart failure (HF) recommend advance care planning and assessment of patients’ end-of-life preferences. However, very few studies have captured these preferences or their relationship with prognosis.

Observational, multicenter, survey-style study of patients aged 75 or older admitted for HF to internal medicine department of 60 Spanish hospitals. Patients were followed for 6 months and mortality, emergency room visits and readmissions were recorded.

A total of 673 patients were included. The median age was 86 years, and they had significant comorbidity, frailty (59%), and a predominance of HF with preserved left ventricular ejection fraction (75%). A total of 92% of patients prioritized quality of life over living longer. A total of 9% had spoken with their physician about cardiopulmonary resuscitation; 29% did not want cardiopulmonary resuscitation, and 37% had not yet decided. About 15% of patients were considering requesting euthanasia. Adequate symptom control, particularly dyspnea and pain, was the patients’ major priority. None of the end-of-life preferences expressed by patients were shown to be an independent prognostic factor at 6 months of follow-up.

Elderly patients with multiple pathologies admitted for HF prioritize quality of life and symptom control over living longer. Advance care planning for them should be systematic and proactive.