Key result
Framing survival as life-years gained increases patient preference for HF medications by ~17 percentage points.
Why the study?
Guideline-recommended HF medications improve quality of life, survival, and hospitalization risk at the expense of pill burden, side effects, and cost. This study assessed how patients with HF weigh the trade-offs between these medication-related benefits and downsides.
Does presenting survival benefits as average life-years gained versus 5-year survival probability alter patient preferences for heart failure medication trade-offs in patients with heart failure?
RCT (n=202)
Randomized to the survival attribute presented as either 5-year survival probability or average life-years gained
Yes
Does presenting survival benefits as average life-years gained versus 5-year survival probability alter patient preferences for heart failure medication trade-offs in patients with heart failure?
Patients with heart failure prioritize medication survival and quality-of-life benefits over pill burden and side effects—unless out-of-pocket costs are high—and show stronger preferences for survival when framed as life-years gained rather than 5-year survival probability.
Framing survival as life-years gained may heighten HF patient preferences; leaves open optimal presentation strategies for shared decision-making.
Background Heart failure (HF) reduces quality of life, decreases survival, and increases the risk of hospitalization. Guideline-recommended medications improve these outcomes at the expense of pill burden, side effects, and cost. Purpose To assess how patients with HF weigh the trade-offs between medication-related benefits and downsides. Methods We administered a discrete-choice experiment to 202 patients with HF from seven HF clinics and three online platforms across Canada. Participants were shown 12 choice-sets, each offering three options: two HF medication regimens and no medication. Each option was described according to its impact on six HF medication attributes (quality of life, survival, all-cause hospitalization, side-effects, out-of-pocket cost, and pill burden). Participants were randomized to the survival attribute presented as either 5-year survival probability (reference) or average life-years gained. We used conditional logistic regression to estimate preference weights, presented as marginal rate of substitution (MRS) using hospitalization as the anchor attribute. Larger MRS values represent stronger preferences. Results The mean age was 63 years and 43% were female. Patients expressed stronger preferences for medication-related benefits, namely for survival (maximum MRS 22.9% for a 15% improvement in 5-year survival) and quality of life (maximum MRS 25.2% for a 60% probability of improved quality of life). Patients placed less importance on downsides (maximum MRS 11.2% for side effects; pill burden not significant), with the exception of the highest cost level ($CAD 4,500 annually; MRS 32.1%). Participants exhibited a strong aversion to the option of taking ‘no medication’ (MRS 54.9%). Presenting survival as life-years gained led to a greater preference for survival improvements (maximum MRS 39.5% vs 22.9% when presented as improvement in 5-year survival). Conclusion For patients with HF, medication benefits generally outweighed the downsides, except for high out-of-pocket costs. Patient preferences are influenced by the format of survival communication, with stronger preferences when the same benefit is presented as life-years gained rather than as improvement of 5-year survival.
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R Turgeon (2026) conducted an RCT in Heart failure (n=202). Survival attribute presented as average life-years gained in a discrete-choice experiment of HF medication regimens vs. 5-year survival probability presentation (and no medication option within choice-sets) was evaluated on Preference weights for HF medication attributes estimated as marginal rate of substitution (MRS) using hospitalization as the anchor attribute. Presenting survival as life-years gained increased patient preference for HF medication survival improvements vs 5-year survival probability (max MRS 39.5% vs 22.9%).
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