PMID- 18523222
OWN - NLM
STAT- MEDLINE
DCOM- 20080611
LR  - 20220330
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Print)
IS  - 0098-7484 (Linking)
VI  - 299
IP  - 21
DP  - 2008 Jun 4
TI  - Discordance between patient-predicted and model-predicted life expectancy among 
      ambulatory patients with heart failure.
PG  - 2533-42
LID - 10.1001/jama.299.21.2533 [doi]
AB  - CONTEXT: Patients with chronic heart failure have impaired long-term survival, 
      but their own expectations regarding prognosis have not been well studied. 
      OBJECTIVES: To quantify expectations for survival in patients with heart failure, 
      to compare patient expectations to model predictions, and to identify factors 
      associated with discrepancies between patient-predicted and model-predicted 
      prognosis. DESIGN, SETTING, AND PARTICIPANTS: Prospective face-to-face survey of 
      patients from the single-center Duke Heart Failure Disease Management Program 
      between July and December 2004, with follow-up through February 2008. 
      Patient-predicted life expectancy was obtained using a visual analog scale. 
      Model-predicted life expectancy was calculated using the Seattle Heart Failure 
      Model. Actuarial-predicted life expectancy, based on age and sex alone, was 
      calculated using life tables. Observed survival was determined from review of 
      medical records and search of the Social Security Death Index. MAIN OUTCOME 
      MEASURE: Life expectancy ratio (LER), defined as the ratio of patient-predicted 
      to model-predicted life expectancy. RESULTS: The cohort consisted of 122 patients 
      (mean age, 62 years; 47% African American, 42% New York Heart Association [NYHA] 
      class III or IV). On average, patients overestimated their life expectancy 
      relative to model-predicted life expectancy (median patient-predicted life 
      expectancy, 13.0 years; model-predicted expectancy, 10.0 years). Median LER was 
      1.4 (interquartile range, 0.8-2.5). Younger age, increased NYHA class, lower 
      ejection fraction, and less depression were the most significant predictors of 
      higher LER. During a median follow-up of 3.1 years, 29% of the original cohort 
      died. There was no association between higher LER and improved survival (adjusted 
      hazard ratio for overestimated compared with concordant LER, 1.05; 95% confidence 
      interval, 0.46-2.42). CONCLUSIONS: Ambulatory patients with heart failure tended 
      to substantially overestimate their life expectancy compared with model-based 
      predictions for survival. Because differences in perceived survival could affect 
      decision making regarding advanced therapies and end-of-life planning, the causes 
      of these discordant predictions warrant further study.
FAU - Allen, Larry A
AU  - Allen LA
AD  - Duke Clinical Research Institute and Division of Cardiology, Durham, NC 27705, 
      USA. larry_allen@post.harvard.edu
FAU - Yager, Jonathan E
AU  - Yager JE
FAU - Funk, Michele Jonsson
AU  - Funk MJ
FAU - Levy, Wayne C
AU  - Levy WC
FAU - Tulsky, James A
AU  - Tulsky JA
FAU - Bowers, Margaret T
AU  - Bowers MT
FAU - Dodson, Gwen C
AU  - Dodson GC
FAU - O'Connor, Christopher M
AU  - O'Connor CM
FAU - Felker, G Michael
AU  - Felker GM
LA  - eng
GR  - T32 HL069749/HL/NHLBI NIH HHS/United States
GR  - K23 HL72357-01A/HL/NHLBI NIH HHS/United States
GR  - 2 T32HL069749-04/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
SB  - IM
CIN - JAMA. 2008 Jun 4;299(21):2566-7. PMID: 18523227
CIN - JAMA. 2008 Nov 12;300(18):2116-7; author reply 2117. PMID: 19001619
MH  - Actuarial Analysis
MH  - Aged
MH  - Aged, 80 and over
MH  - *Attitude to Health
MH  - Chronic Disease
MH  - Female
MH  - Heart Failure/*mortality/*psychology
MH  - Humans
MH  - *Life Expectancy
MH  - Male
MH  - Middle Aged
MH  - *Models, Cardiovascular
MH  - Prognosis
MH  - Surveys and Questionnaires
MH  - Survival Analysis
PMC - PMC3623529
MID - NIHMS452436
EDAT- 2008/06/05 09:00
MHDA- 2008/06/12 09:00
PMCR- 2013/04/11
CRDT- 2008/06/05 09:00
PHST- 2008/06/05 09:00 [pubmed]
PHST- 2008/06/12 09:00 [medline]
PHST- 2008/06/05 09:00 [entrez]
PHST- 2013/04/11 00:00 [pmc-release]
AID - 299/21/2533 [pii]
AID - 10.1001/jama.299.21.2533 [doi]
PST - ppublish
SO  - JAMA. 2008 Jun 4;299(21):2533-42. doi: 10.1001/jama.299.21.2533.