Heart failure, which occurs when the heart is too weak to pump enough blood to meet the body's needs, causes 55,000 deaths each year and indirectly contributes to 230,000 more deaths annually in the U.S.
Although there have been recent improvements in congestive heart failure treatment, researchers say the prognosis for people with the disease is still bleak, with about 50% having an average life expectancy of less than five years. For those with advanced forms of heart failure, nearly 90% die within one year.
"Patient perception of prognosis is important because it fundamentally influences medical decision making regarding medications, devices, transplantation, and end-of-life care," write researcher Larry A. Allen, MD, MHS, of the Duke Clinical Research Institute and colleagues in The Journal of the American Medical Association.
Heart Failure Expectations Unrealistic?
In the study, researchers surveyed 122 people (average age 62) with moderate to advanced congestive heart failure about their perception of their life expectancy.
They found the heart failure patients tended to overestimate their life expectancy by about three years. The average patient survival estimate was 13 years compared with a validated medical model estimate of 10 years.
Overall, 63% of people with heart failure overestimated their remaining life expectancy by an average of 40% compared with medical model predictions. Those who were younger and with more advanced disease were most likely to overestimate how long they had left to live.
During the three-year follow-up period, 29% of the people involved in the survey died. Researchers found no relationship between longer life expectancy perceptions and survival.
Life Expectancy an Individual Matter
"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," write the researchers. "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."
In an editorial that accompanies the study, Clyde W. Yancy, MD, of Baylor University Medical Center in Dallas, writes that predicting life expectancy in people with heart failure is not an exact science and many questions remain about clinical prediction models.
Therefore, until these issues are fully addressed, people should embrace an individualized decision-making process regarding end-of-life care guided by physician input.