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Perceptions of advanced HF severity differ between patients, physicians
Patients with advanced HF were more likely to be identified by physicians as high risk for transplant, left ventricular assist device implantation or death than to perceive themselves as high risk, according to findings.
“Patient-centered care for patients with advanced HF requires that patients understand possible outcomes and learn about potential treatment options including LVAD surgery, which can improve quality of life and functional capacity for patients limited by HF symptoms, even when death is not imminent,” Amrut V. Ambardekar, MD, an assistant professor in the division of cardiology at the University of Colorado, Aurora, and colleagues wrote. “However, patients may not fully appreciate the invasive procedures that may be required for support during the postoperative period.”
Ambardekar and colleagues enrolled 161 patients with advanced HF on optimized medical therapy across 11 centers. The treating cardiologist rated patients for perceived risk for transplant, LVAD or death for the next 12 months.
Participants were surveyed regarding their own perception of life expectancy and willingness to undergo various interventions.
At baseline, the treating cardiologists regarded 69% of the participants as high risk, yet only 14% of patients reported believing they were high risk.
After a mean follow-up of 13 months, 38% of participants experienced an endpoint; 21% died, 8% had a transplant and 9% were implanted with an LVAD.
“It was surprising that there were such drastic differences between patient perceptions and physician perceptions of heart failure disease severity,” Ambardekar said in a press release. “We hope better understanding these differences will facilitate improved patient-physician communication regarding advanced heart failure therapies.”
Of those identified as high risk by physicians, 77% said they would be willing to consider LVAD, but 63% said they would decline one or more other simpler forms of life-sustaining therapy — ventilation, dialysis or a feeding tube.
The researchers wrote these inconsistencies have to do with poor understanding of treatment options.
“As there are growing treatment options, most notably with LVAD therapy, available for this cohort of advanced HF patients, earlier discussion regarding disease severity and treatment options are needed so that patients may make well-informed decisions,” the researchers wrote. – by Cassie Homer
Disclosure s : Ambardekar reports no relevant financial disclosures. One author reports receiving support from the Amgen, Maquet, Novartis and Thoratec, and consulting for Maquet. Another reports receiving advertising board and speaker honoraria from Abiomed, CareDx and HeartWare as well as receiving support from Sunshine Heart and Thoratec.