Perceptions of Risk Level Differ Between HF Patients, Physicians

Physicians identified a majority of patients with advanced heart failure as being at high risk for transplant, left ventricular assist device (LVAD) or death while few of those patients considered themselves to be at high risk, according to a study published August 16 in JACC: Heart Failure.

Amrut V. Ambardekar, MD, FACC, et al., rated 161 patients for perceived risk for transplant, LVAD or death in the coming year. The patients were also surveyed about their perceptions of their life expectancy and willingness to undergo different treatment options. The researchers found that 69 percent of the patients were considered at high risk for transplant, LVAD or death by their physicians. However, only 14 percent of patients considered themselves to be at high risk. Over 13 months of follow-up, 38 percent of patients experienced an endpoint: 21 percent were deaths, 8 percent transplants and 9 percent LVAD implants.

Researchers also assessed patient willingness to consider other life-sustaining therapies to treat advanced heart failure, such as ventilation, dialysis or a feeding tube. Among the patients identified as high risk by physicians, 77 percent were willing to consider LVAD, but 63 percent indicated they would decline other simpler life-sustaining therapies.

“More than likely, these inconsistencies indicate a poor understanding of these treatment options,” Ambardekar says. “Patients may not fully appreciate the invasive nature of some of these procedures, so we probably need to look for better ways to educate our patients both on the severity of their disease and their treatment options – well before they need these advanced therapies.”

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support

Keywords: Heart-Assist Devices, Life Expectancy, Research Personnel, Follow-Up Studies, Heart Failure, Physician-Patient Relations, Physicians

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