Younger Heart Failure Patients More Likely than
Seniors to Overestimate Life Expectancy
But majority of patients in study think they will
live longer than clinical prediction
June
3, 2006 Senior citizens, especially those without the most severe
heart failures, are more realistic about their condition and remaining
life span than are younger heart failure patients, who are most likely
to overestimate their chances of survival.
Patient perception of prognosis is important
because it fundamentally influences medical decision making regarding
medications, devices, transplantation, and end-of-life care, write the
authors of a study in the June 4 issue of the Journal of the American
Medical Association.
Thiazolidinediones medications (including rosiglitazone
(Avandia)
produced a significantly increased risk of heart attack, congestive
heart failure and death
Many patients with heart failure have survival
expectations that are significantly greater than clinical predictions,
with younger patients and those with more severe disease more likely to
overestimate their remaining life span, according to a study in the June
4 issue of JAMA.
Heart failure accounts directly for 55,000 deaths
and indirectly for an additional 230,000 deaths in the United States
each year, according to the study.
Despite advances in care, the prognosis for
patients with symptomatic heart failure remains poor with less than
half surviving for five years.
For those with the most advanced disease, 1-year
mortality rates approach 90 percent.
Prognosis is dependent on various patient
characteristics, and a number of prognostic models have been developed
to help predict survival in patients with heart failure.
Larry A. Allen, M.D., M.H.S., of the Duke Clinical
Research Institute, Durham, N.C., and colleagues conducted a study to
determine the personal predictions of life expectancy of 122 patients
with heart failure (who were not bed-ridden) and compared those with
each of their model-estimated life expectancy predictions.
About Heart Diseases
Also called: Cardiac disease
If you're like most
people, you think that heart disease is a problem for other
folks. But heart disease is the number one killer in the U.S. It
is also a major cause of disability.
There are many
different forms of heart disease.
The most common
cause of heart disease is narrowing or blockage of the coronary
arteries, the blood vessels that supply blood to the heart
itself. This is called
coronary
artery disease and happens slowly over time. It's the
major reason people have
heart
attacks.
Other kinds of heart problems may happen
to the
valves
in the heart, or the heart may not pump well and cause
heart
failure. Some people are
born
with heart disease.
You can help reduce your risk of heart
disease by taking steps to control factors that put you at
greater risk:
● Control your
blood
pressure
● Lower your
cholesterol
● Don't smoke
● Get enough exercise
Heart failure is a condition in which the
heart can't pump enough blood throughout the body. Heart failure
does not mean that your heart has stopped or is about to stop
working. It means that your heart is not able to pump blood the
way it should.
The weakening of the heart's pumping
ability causes
● Blood and fluid to back up into the lungs
● The buildup of fluid in the feet, ankles and legs - called
edema
● Tiredness and shortness of breath
Each year over a million people in the
U.S. have a heart attack. About half of them die. Many people
have permanent heart damage or die because they don't get help
immediately. It's important to know the symptoms of a heart
attack and call 9-1-1 if someone is having them.
Those symptoms include
● Chest discomfort - pressure, squeezing, or pain
● Shortness of breath
● Discomfort in the upper body - arms, shoulder, neck, back
● Nausea, vomiting, dizziness, lightheadedness, sweating
These symptoms can sometimes be different
in
women.
What exactly is a heart attack? Most
heart attacks happen when a clot in the coronary artery blocks
the supply of blood and oxygen to the heart. Often this leads to
an irregular heartbeat called an
arrhythmia - that causes a severe decrease in the pumping
function of the heart. A blockage that is not treated within a
few hours causes the affected heart muscle to die.
The patients had an average age 62 years and 47
percent African American. And, 42 percent were New York Heart
Association class III or IV [more severe heart failure]) patients. All
were surveyed regarding their predicted life expectancy.
Model-predicted life expectancy was calculated
using the Seattle Heart Failure Model (SHFM).
On average, patients overestimated their life
expectancy relative to model-predicted life expectancy. The median
patient-predicted life expectancy was 13.0 years and the model-predicted
expectancy was 10.0 years.
The majority of patients - 65 percent (77) -
overestimated their life expectancy when compared with that predicted by
the SHFM.
The median life expectancy ratio (LER; i.e., ratio
of patient-predicted to model-predicted life expectancy) was 1.4,
meaning the median overestimation of predicted future survival in the
population was 40 percent. There was no association between higher LER
and improved survival.
Thirty-five patients (29 percent) died over a
median follow-up period of 3.1 years.
There was little relationship between
patient-predicted and model-predicted life expectancy.
Patient predictions of life expectancy were more
similar to those predicted by empirically derived actuarial life tables
based on age and sex alone, without regard for the presence of heart
failure.
Patient characteristics that were predictive of
overestimation of life expectancy included younger age, more severe
disease and less depression.
The exact reasons for this incongruity are unknown
but they may reflect hope or may result from inadequate communication
between clinicians and their patients about prognosis, according to the
report.
Because differences in expectations about
prognosis could affect decision making regarding advanced therapies and
end-of-life planning, further research into both the extent and the
underlying causes of these differences is warranted. Whether
interventions designed to improve communication of prognostic
information between clinicians and patients would improve the process of
care in heart failure should be tested in appropriately designed
clinical trials, the authors conclude.
Editorial: Predicting life expectancy in heart
failure
In an accompanying editorial, Clyde W. Yancy, M.D.,
of the Baylor University Medical Center, Dallas, writes that questions
remain regarding the accuracy of clinical prediction models.
Currently, there is insufficient precision in the
prognostication of heart failure, and decision making at the end of life
is perhaps the most personalized of all decision making in medicine.
Although well-intended and carefully constructed tools and awareness of
the natural history of disease are helpful, it is the primacy of the
patient-physician interface that must prevail.
Until these questions are fully addressed, it is
best to avoid adopting an imprecise method, instead continuing to
embrace the individualized decision-making process guided by physician
judgment that incorporates all patient care considerations.
Keep up with the latest news for senior citizens, baby
bommers
June
3, 2006 Senior citizens, especially those without the most severe
heart failures, are more realistic about their condition and remaining
life span than are younger heart failure patients, who are most likely
to overestimate their chances of survival.