In the survey of patients and physicians, doctors thought that 69
percent of patients were likely to die or need a transplant or
what’s know as a left ventricular assist device (LVAD) to help their
heart keep pumping within the next year.
But just 14 percent of patients expected any of these outcomes to
happen to them, researchers report in JACC: Heart Failure.
“Part of this is that hope is human nature - patients think they
will beat the odds,” said lead study author Dr. Amrut Ambardekar,
medical director of the cardiac transplant program at the University
of Colorado in Aurora.
Almost 6 million Americans have heart failure, and it’s one of the
most common reasons older adults go to the hospital, according to
the American Heart Association.
It happens when the heart muscle is too weak to pump enough blood
through the body. Symptoms can include fatigue, weight gain from
fluid retention, shortness of breath and coughing or wheezing.
Medications can help strengthen the heart and minimize fluid buildup
in the body.
A realistic assessment of a patient's prospects is needed to make
decisions about interventions like heart transplantation or LVAD,
the study team writes.
Unlike many other chronic health problems, the disease doesn’t
progress in a linear way, and that may contribute to the mismatch in
expectations between patients and doctors, Ambardekar said by email.
“Patients have a hard time knowing their odds for survival as they
may have been at a low, but then responded to a treatment and
stabilized,” Ambardekar said. “Patients may have been sick, but then
responded to treatments in the past so they think they will respond
For the study, physicians rated 161 patients on perceived risk for
transplant, LVAD or death in the upcoming year. The patients rated
themselves on the same risks.
Predictions by both patients and physicians turned out to be poor,
the study team notes.
[to top of second column]
Overall, 21 percent of patients died during the study period.
Another 8 percent got transplants and 9 percent received LVAD
Researchers also assessed whether patients were willing to consider
other life-sustaining therapies to treat advanced heart failure,
such as ventilation to help with breathing, dialysis to do the job
of failing kidneys or a feeding tube.
While 77 percent of the patients considered high risk by physicians
said they would consider LVAD, 66 percent of them said they would
decline other life-sustaining therapies.
Beyond its small size, another limitation of the study is that
patients and doctors were surveyed only once, at the start of the
study, and it’s possible their perceptions of risk and willingness
to consider certain therapies or treatments might change over time,
the authors note.
Even so, it suggests that there’s room for improvement in how
doctors and patients communicate, said Dr. Roberta Florido, a
researcher at Johns Hopkins University in Baltimore who wasn’t
involved in the study.
“Whether altering one’s perception of their prognosis through
enhanced information makes them `healthier or happier longer’ is
unknown,” Florido said by email. “However, when patients are more
knowledgeable about their prognosis and care options, they are more
likely to make informed decisions about their goals and receive
medical care that is aligned with their preferences.”
SOURCE: http://bit.ly/2wF5TuC JACC: Heart Failure, online August 16,
[© 2017 Thomson Reuters. All rights
Copyright 2017 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.