Larry A. Allen|Jonathan E.E. Yager|Michele Jönsson Funk|Wayne C. Levy|James A. Tulsky|Matthew T. Bowers|Gwen C. Dodson|Christopher M. O’Connor|G. Michael Felker
Discordance Between Patient-Predicted and Model-Predicted Life Expectancy Among Ambulatory Patients With Heart Failure
Clinical Research Institute
h3contexth3patients chronic heart failure impaired longterm survival expectations regarding prognosis well studiedh3objectivesh3to quantify expectations survival patients heart failure compare patient expectations model predictions identify factors associated discrepancies patientpredicted modelpredicted prognosish3design setting participantsh3prospective facetoface survey patients singlecenter duke heart failure disease management program july december 2004 followup february 2008 patientpredicted life expectancy obtained using visual analog scale modelpredicted life expectancy calculated using seattle heart failure model actuarialpredicted life expectancy based age sex alone calculated using life tables observed survival determined review medical records search social security death indexh3main outcome measureh3life expectancy ratio ler defined ratio patientpredicted modelpredicted life expectancyh3resultsh3the cohort consisted 122 patients mean age 62 years 47 african american 42 new york heart association nyha class iii iv average patients overestimated life expectancy relative modelpredicted life expectancy median patientpredicted life expectancy 130 years modelpredicted expectancy 100 years median ler 14 interquartile range 0825 younger age increased nyha class lower ejection fraction less depression significant predictors higher ler median followup 31 years 29 original cohort died association higher ler improved survival adjusted hazard ratio overestimated compared concordant ler 105 95 confidence interval 046242h3conclusionsh3ambulatory patients heart failure tended substantially overestimate life expectancy compared modelbased predictions survival differences perceived survival could affect decision making regarding advanced therapies endoflife planning causes discordant predictions warrant study