Friday, June 13, 2008

Heart failure patients overestimate their life span
By Kelly Winget

Patients who have heart failure often have as high of a five-year mortality rate as many cancer patients, but many who live with heart failure overestimate how long they will live, according to a new study led by the DCRI's Larry Allen, MD, MHS.

Having realistic expectations about life span is important for planning advanced medical care and planning for end-of-life care, the researchers noted.

“Patients perceive heart failure differently than cancer,” said Dr. Allen. “Patients view heart failure in the context of general aging.”

For the new study, which was published in the June 4 edition of the Journal of the American Medical Association, researchers surveyed patients in the Duke Heart Failure Disease Management program about their life expectancy. The patient responses were then compared with life expectancy predictions from the Seattle Heart Failure model, and also compared with predictions based only on gender and age, which were calculated using life tables.

Researchers found a significant gap between how long the patients predicted they would live and the Seattle model predictions. The Seattle Heart Failure model is a well-recognized tool used in the treatment of heart failure patients. For the patient responses, researchers asked them 63 questions, including asking if they thought their heart failure would be cured; if they thought they would have a normal life expectancy but live with heart failure for their rest of their lives, or if they thought that heart failure would shorten their life expectancy.

Patients overestimated how long they would live by an average of 40 percent, according to the study results. Patients on average thought they would live an additional 13 years, and the Seattle Heart Failure model predicted they would live for an average of 10 years. Patients' expectations more closely matched the life tables, which only considered gender and age, and did not factor in heart failure.

For the study, 122 patients completed the questionnaires, and within that group, 45 percent were over 65 years old, and 83 percent had lived with heart failure for more than a year. Researchers also found that patients who had mild heart failure and severe heart failure still rated their life expectancy about the same, which indicated to researchers that the patients didn't understand how heart failure impacts their survival.

“We want patients to prepare for the worst, but hope for the best,” said Dr. Allen. “Patients with heart failure need to make decisions about possible advanced medical therapies and need to think ahead to end-of-life planning.”

Heart failure patients can often benefit from therapies that include ACE inhibitors to widen blood vessels, beta-blockers to help improve the heart's ability to pump blood, and for patients with more advanced heart failure, implanted medical devices or heart transplants are often considered. Dr. Allen suggests that patients could possibly approach these decisions better if they have an improved understanding of the risks associated with heart failure.

The researchers recommend further clinical trials to determine if improving communication about a heart failure prognosis between clinicians and patients would help improve the process of care in heart failure.

This was Dr. Allen's first research to be published in JAMA, and it is uncommon for a fellow research project to get published in such a high-impact journal. Other DCRI researchers involved with the study include Margaret Bowers, RN, MSN, Gwen Dodson, RN, MSN, Christopher O'Connor, MD, and Michael Felker, MD, MHS.