What question did this study set out to answer?

To quantify survival expectations among ambulatory patients with heart failure, compare these expectations to model-based estimates, and identify factors linked to prediction discrepancies.

June 3, 2008JAMAOpen Access

Discordance Between Patient-Predicted and Model-Predicted Life Expectancy Among Ambulatory Patients With Heart Failure

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To quantify survival expectations among ambulatory patients with heart failure, compare these expectations to model-based estimates, and identify factors linked to prediction discrepancies.
Prospective face-to-face survey of 122 ambulatory heart failure patients (mean age 62 years, 47% African American, 42% NYHA class III/IV) at a single center with median follow-up of 3.1 years.
Measured patient-predicted life expectancy using a visual analog scale and compared it to Seattle Heart Failure Model predictions to calculate the life expectancy ratio (LER).
Patients significantly overestimated their survival relative to model predictions, with a median patient-predicted life expectancy of 13.0 years versus 10.0 years predicted by the model (median LER, 1.4; IQR, 0.8-2.5).
Younger age, more advanced NYHA functional class, lower left ventricular ejection fraction, and lower depression scores were significant independent predictors of higher LER.
During follow-up, 29% of patients died, and optimism in survival was not associated with improved actual survival (adjusted HR for overestimated vs concordant LER, 1.05; 95% CI, 0.46-2.42).

Structured PICO

Population

122 ambulatory patients with heart failure from a single-center disease management program, mean age 62 years, 47% African American, 42% NYHA class III or IV.

Outcome

Life expectancy ratio (LER), defined as the ratio of patient-predicted to model-predicted life expectancypatient reported

Ambulatory patients with heart failure substantially overestimate their life expectancy compared with validated prognostic models, highlighting a discordance that may impact decision-making for advanced therapies and end-of-life planning.

Discussion

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Implication

HF patients' survival overestimation warrants caution in discussions; this cohort study leaves open effects on decisions or outcomes.

Cite This Study

Larry A. Allen (2008) studied this question.

synapsesocial.com/papers/6a6f7788a528af2d65c30112 https://doi.org/10.1001/jama.299.21.2533

Topics

Heart failure HFrEF treatment

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Discordance Between Patient-Predicted and Model-Predicted Life Expectancy Among Ambulatory Patients With Heart Failure

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Discordance Between Patient-Predicted and Model-Predicted Life Expectancy Among Ambulatory Patients With Heart Failure

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

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