PMID- 18765193
OWN - NLM
STAT- MEDLINE
DCOM- 20090213
LR  - 20151119
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 27
IP  - 9
DP  - 2008 Sep
TI  - Choices: a study of preferences for end-of-life treatments in patients with 
      advanced heart failure.
PG  - 1002-7
LID - 10.1016/j.healun.2008.06.002 [doi]
AB  - BACKGROUND: The purpose of this study is to describe the treatment preferences of 
      patients with heart failure among three distinct treatment options--optimal 
      medical management, oral inotropes or left ventricular device (LVAD) support--to 
      determine if there were differences in preferences between patients with mild 
      heart failure (New York Heart Association [NYHA] Class II) and severe heart 
      failure (NYHA Class IV), and also to determine whether quality of life, perceived 
      severity of symptoms and overall health influenced treatment preferences. 
      METHODS: We enrolled 91 patients who completed the Minnesota Living with Heart 
      Failure Questionnaire (MLHFQ); visual analog scales for depicting their perceived 
      severity of overall health, dyspnea and fatigue; and a treatment trade-off tool. 
      RESULTS: The most preferred treatment options were oral inotropes, LVAD and 
      standard medical management. There were no differences in treatment preferences 
      between NYHA II and NYHA IV patients. Patient preferences correlated poorly with 
      MLHFQ, symptom and overall health scores. Although not statistically significant, 
      there was a trend toward patients with worse quality of life and symptom scores 
      preferring more aggressive treatment. CONCLUSIONS: The results of our study 
      identified two distinct groups of patients: one group preferring treatments that 
      prolonged survival time and another group that favored strategies that improved 
      quality of life but reduced survival time. Treatment preferences were independent 
      of functional or symptom status, suggesting that preferences may be decided early 
      in the course of illness.
FAU - MacIver, Jane
AU  - MacIver J
AD  - Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, 
      Toronto, Ontario, Canada.
FAU - Rao, Vivek
AU  - Rao V
FAU - Delgado, Diego H
AU  - Delgado DH
FAU - Desai, Nimesh
AU  - Desai N
FAU - Ivanov, Joan
AU  - Ivanov J
FAU - Abbey, Susan
AU  - Abbey S
FAU - Ross, Heather J
AU  - Ross HJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20080726
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
RN  - 0 (Cardiotonic Agents)
SB  - IM
MH  - Adult
MH  - Advance Care Planning/*statistics & numerical data
MH  - Aged
MH  - Attitude to Health
MH  - Cardiotonic Agents/therapeutic use
MH  - *Choice Behavior
MH  - *Defibrillators, Implantable
MH  - Dyspnea
MH  - Fatigue
MH  - Female
MH  - Heart Failure/drug therapy/*psychology/*therapy
MH  - *Heart-Assist Devices
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Ontario
MH  - *Quality of Life
MH  - Severity of Illness Index
MH  - Surveys and Questionnaires
MH  - Young Adult
EDAT- 2008/09/04 09:00
MHDA- 2009/02/14 09:00
CRDT- 2008/09/04 09:00
PHST- 2007/09/04 00:00 [received]
PHST- 2008/05/01 00:00 [revised]
PHST- 2008/06/03 00:00 [accepted]
PHST- 2008/09/04 09:00 [pubmed]
PHST- 2009/02/14 09:00 [medline]
PHST- 2008/09/04 09:00 [entrez]
AID - S1053-2498(08)00435-X [pii]
AID - 10.1016/j.healun.2008.06.002 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2008 Sep;27(9):1002-7. doi: 
      10.1016/j.healun.2008.06.002. Epub 2008 Jul 26.