Magazine article Clinical Psychiatry News

Heart Failure Patients Overestimate Life Expectancy

Magazine article Clinical Psychiatry News

Heart Failure Patients Overestimate Life Expectancy

Article excerpt

Ambulatory patients with heart failure tend to substantially overestimate their life expectancy, especially those who are younger or who have severe disease, investigators reported.

Their misperception could "fundamentally influence medical decision making regarding medications, devices, transplantation, and end-of-life care," said Dr. Larry A. Allen of the Duke Clinical Research Institute in Durham, N.C., and his associates.

The researchers surveyed 122 patients with a broad spectrum of heart failure severity to determine their understanding of their prognoses. "Despite advances in care, the prognosis for patients with symptomatic HF remains poor, with a median life expectancy of less than 5 years," the investigators noted.

Most of the study subjects had longstanding chronic heart failure and comorbid conditions such as hypertension and diabetes. The sample was racially diverse and included a large number of elderly people.

The patients' predictions were compared with those obtained using the Seattle Heart Failure Model, a prognostic tool that calculates life expectancy based on clinical characteristics, medications, device use, and results of diagnostic testing, they said.

A total of 9% of the subjects believed their heart failure would be cured, and an additional 51% believed they would always have heart failure but nevertheless would have a normal life expectancy. Only 36% indicated that heart failure would likely shorten their lives.

A total of 63% of patients markedly overestimated their life expectancy, thinking they'd survive a median of 40% longer than predicted by the clinical prognostic tool, Dr. Allen and his associates said (JAMA 2008;299:2533-42).

Patients also predicted they would live a median of another 13 years. In contrast, the clinical model predicted a median survival of 10 years. The model came close to predicting actual survival rates at 1 and 3 years of follow-up. …

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