Discordant Perceptions of Prognosis and Treatment Options Between Physicians and Patients With Advanced Heart Failure

Amrut V. Ambardekar, Jennifer T. Thibodeau, Adam D. DeVore, Michelle M. Kittleson, Rhondalyn C. Forde-McLean, Maryse Palardy, Maria M. Mountis, Linda Cadaret, Jeffrey J. Teuteberg, Salpy V. Pamboukian, Rongbing Xie, Lynne W. Stevenson, Garrick C. Stewart

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objectives: This study assessed patient and physician perceptions of heart failure (HF) disease severity and treatment options. Background: The prognosis for ambulatory patients with advanced HF on medical therapy is uncertain, yet has important implications for decision making regarding transplantation and left ventricular assist device (LVAD) placement. Methods: Ambulatory patients with advanced HF (New York Heart Association functional class III to IV, Interagency Registry for Mechanically Assisted Circulatory Support profiles 4 to 7) on optimized medical therapy were enrolled across 11 centers. At baseline, treating cardiologists rated patients for perceived risk for transplant, LVAD, or death in the upcoming year. Patients were also surveyed about their own perceptions of life expectancy and willingness to undergo various interventions. Results: At enrollment, physicians regarded 111 of 161 patients (69%) of the total cohort to be at high risk for transplant, LVAD, or death, whereas only 23 patients (14%) felt they were at high risk. After a mean follow-up of 13 months, 61 patients (38%) experienced an endpoint of 33 deaths (21%), 13 transplants (8%), and 15 LVAD implants (9%). There was poor discrimination between risk prediction among both patients and physicians. Among physician-identified high-risk patients, 77% described willingness to consider LVAD, but 63% indicated that they would decline 1 or more other simpler forms of life-sustaining therapy such as ventilation, dialysis, or a feeding tube. Conclusions: Among patients with advanced HF, physicians identified most to be at high risk for transplantation, LVAD, or death, whereas few patients recognized themselves to be at high risk. Patients expressed inconsistent attitudes toward lifesaving treatments, possibly indicating poor understanding of these therapies. Educational interventions regarding disease severity and treatment options should be introduced prior to the need for advanced therapies such as intravenous inotropic therapy, transplantation, or LVAD.

Original languageEnglish (US)
JournalJACC: Heart Failure
DOIs
StateAccepted/In press - 2017

Fingerprint

Heart Failure
Physicians
Heart-Assist Devices
Therapeutics
Transplantation
Transplants
Enteral Nutrition
Life Expectancy
Ventilation
Registries
Dialysis
Heart Diseases
Decision Making

Keywords

  • Advanced heart failure
  • Cardiac transplantation
  • Mechanical circulatory support
  • Patient decision making
  • Ventricular assist device

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Discordant Perceptions of Prognosis and Treatment Options Between Physicians and Patients With Advanced Heart Failure. / Ambardekar, Amrut V.; Thibodeau, Jennifer T.; DeVore, Adam D.; Kittleson, Michelle M.; Forde-McLean, Rhondalyn C.; Palardy, Maryse; Mountis, Maria M.; Cadaret, Linda; Teuteberg, Jeffrey J.; Pamboukian, Salpy V.; Xie, Rongbing; Stevenson, Lynne W.; Stewart, Garrick C.

In: JACC: Heart Failure, 2017.

Research output: Contribution to journalArticle

Ambardekar, AV, Thibodeau, JT, DeVore, AD, Kittleson, MM, Forde-McLean, RC, Palardy, M, Mountis, MM, Cadaret, L, Teuteberg, JJ, Pamboukian, SV, Xie, R, Stevenson, LW & Stewart, GC 2017, 'Discordant Perceptions of Prognosis and Treatment Options Between Physicians and Patients With Advanced Heart Failure', JACC: Heart Failure. https://doi.org/10.1016/j.jchf.2017.04.009
Ambardekar, Amrut V. ; Thibodeau, Jennifer T. ; DeVore, Adam D. ; Kittleson, Michelle M. ; Forde-McLean, Rhondalyn C. ; Palardy, Maryse ; Mountis, Maria M. ; Cadaret, Linda ; Teuteberg, Jeffrey J. ; Pamboukian, Salpy V. ; Xie, Rongbing ; Stevenson, Lynne W. ; Stewart, Garrick C. / Discordant Perceptions of Prognosis and Treatment Options Between Physicians and Patients With Advanced Heart Failure. In: JACC: Heart Failure. 2017.
@article{da41e6d5d9ae43b29af59d2cd592b6b9,
title = "Discordant Perceptions of Prognosis and Treatment Options Between Physicians and Patients With Advanced Heart Failure",
abstract = "Objectives: This study assessed patient and physician perceptions of heart failure (HF) disease severity and treatment options. Background: The prognosis for ambulatory patients with advanced HF on medical therapy is uncertain, yet has important implications for decision making regarding transplantation and left ventricular assist device (LVAD) placement. Methods: Ambulatory patients with advanced HF (New York Heart Association functional class III to IV, Interagency Registry for Mechanically Assisted Circulatory Support profiles 4 to 7) on optimized medical therapy were enrolled across 11 centers. At baseline, treating cardiologists rated patients for perceived risk for transplant, LVAD, or death in the upcoming year. Patients were also surveyed about their own perceptions of life expectancy and willingness to undergo various interventions. Results: At enrollment, physicians regarded 111 of 161 patients (69{\%}) of the total cohort to be at high risk for transplant, LVAD, or death, whereas only 23 patients (14{\%}) felt they were at high risk. After a mean follow-up of 13 months, 61 patients (38{\%}) experienced an endpoint of 33 deaths (21{\%}), 13 transplants (8{\%}), and 15 LVAD implants (9{\%}). There was poor discrimination between risk prediction among both patients and physicians. Among physician-identified high-risk patients, 77{\%} described willingness to consider LVAD, but 63{\%} indicated that they would decline 1 or more other simpler forms of life-sustaining therapy such as ventilation, dialysis, or a feeding tube. Conclusions: Among patients with advanced HF, physicians identified most to be at high risk for transplantation, LVAD, or death, whereas few patients recognized themselves to be at high risk. Patients expressed inconsistent attitudes toward lifesaving treatments, possibly indicating poor understanding of these therapies. Educational interventions regarding disease severity and treatment options should be introduced prior to the need for advanced therapies such as intravenous inotropic therapy, transplantation, or LVAD.",
keywords = "Advanced heart failure, Cardiac transplantation, Mechanical circulatory support, Patient decision making, Ventricular assist device",
author = "Ambardekar, {Amrut V.} and Thibodeau, {Jennifer T.} and DeVore, {Adam D.} and Kittleson, {Michelle M.} and Forde-McLean, {Rhondalyn C.} and Maryse Palardy and Mountis, {Maria M.} and Linda Cadaret and Teuteberg, {Jeffrey J.} and Pamboukian, {Salpy V.} and Rongbing Xie and Stevenson, {Lynne W.} and Stewart, {Garrick C.}",
year = "2017",
doi = "10.1016/j.jchf.2017.04.009",
language = "English (US)",
journal = "JACC: Heart Failure",
issn = "2213-1779",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Discordant Perceptions of Prognosis and Treatment Options Between Physicians and Patients With Advanced Heart Failure

AU - Ambardekar, Amrut V.

AU - Thibodeau, Jennifer T.

AU - DeVore, Adam D.

AU - Kittleson, Michelle M.

AU - Forde-McLean, Rhondalyn C.

AU - Palardy, Maryse

AU - Mountis, Maria M.

AU - Cadaret, Linda

AU - Teuteberg, Jeffrey J.

AU - Pamboukian, Salpy V.

AU - Xie, Rongbing

AU - Stevenson, Lynne W.

AU - Stewart, Garrick C.

PY - 2017

Y1 - 2017

N2 - Objectives: This study assessed patient and physician perceptions of heart failure (HF) disease severity and treatment options. Background: The prognosis for ambulatory patients with advanced HF on medical therapy is uncertain, yet has important implications for decision making regarding transplantation and left ventricular assist device (LVAD) placement. Methods: Ambulatory patients with advanced HF (New York Heart Association functional class III to IV, Interagency Registry for Mechanically Assisted Circulatory Support profiles 4 to 7) on optimized medical therapy were enrolled across 11 centers. At baseline, treating cardiologists rated patients for perceived risk for transplant, LVAD, or death in the upcoming year. Patients were also surveyed about their own perceptions of life expectancy and willingness to undergo various interventions. Results: At enrollment, physicians regarded 111 of 161 patients (69%) of the total cohort to be at high risk for transplant, LVAD, or death, whereas only 23 patients (14%) felt they were at high risk. After a mean follow-up of 13 months, 61 patients (38%) experienced an endpoint of 33 deaths (21%), 13 transplants (8%), and 15 LVAD implants (9%). There was poor discrimination between risk prediction among both patients and physicians. Among physician-identified high-risk patients, 77% described willingness to consider LVAD, but 63% indicated that they would decline 1 or more other simpler forms of life-sustaining therapy such as ventilation, dialysis, or a feeding tube. Conclusions: Among patients with advanced HF, physicians identified most to be at high risk for transplantation, LVAD, or death, whereas few patients recognized themselves to be at high risk. Patients expressed inconsistent attitudes toward lifesaving treatments, possibly indicating poor understanding of these therapies. Educational interventions regarding disease severity and treatment options should be introduced prior to the need for advanced therapies such as intravenous inotropic therapy, transplantation, or LVAD.

AB - Objectives: This study assessed patient and physician perceptions of heart failure (HF) disease severity and treatment options. Background: The prognosis for ambulatory patients with advanced HF on medical therapy is uncertain, yet has important implications for decision making regarding transplantation and left ventricular assist device (LVAD) placement. Methods: Ambulatory patients with advanced HF (New York Heart Association functional class III to IV, Interagency Registry for Mechanically Assisted Circulatory Support profiles 4 to 7) on optimized medical therapy were enrolled across 11 centers. At baseline, treating cardiologists rated patients for perceived risk for transplant, LVAD, or death in the upcoming year. Patients were also surveyed about their own perceptions of life expectancy and willingness to undergo various interventions. Results: At enrollment, physicians regarded 111 of 161 patients (69%) of the total cohort to be at high risk for transplant, LVAD, or death, whereas only 23 patients (14%) felt they were at high risk. After a mean follow-up of 13 months, 61 patients (38%) experienced an endpoint of 33 deaths (21%), 13 transplants (8%), and 15 LVAD implants (9%). There was poor discrimination between risk prediction among both patients and physicians. Among physician-identified high-risk patients, 77% described willingness to consider LVAD, but 63% indicated that they would decline 1 or more other simpler forms of life-sustaining therapy such as ventilation, dialysis, or a feeding tube. Conclusions: Among patients with advanced HF, physicians identified most to be at high risk for transplantation, LVAD, or death, whereas few patients recognized themselves to be at high risk. Patients expressed inconsistent attitudes toward lifesaving treatments, possibly indicating poor understanding of these therapies. Educational interventions regarding disease severity and treatment options should be introduced prior to the need for advanced therapies such as intravenous inotropic therapy, transplantation, or LVAD.

KW - Advanced heart failure

KW - Cardiac transplantation

KW - Mechanical circulatory support

KW - Patient decision making

KW - Ventricular assist device

UR - http://www.scopus.com/inward/record.url?scp=85027492633&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85027492633&partnerID=8YFLogxK

U2 - 10.1016/j.jchf.2017.04.009

DO - 10.1016/j.jchf.2017.04.009

M3 - Article

C2 - 28822745

AN - SCOPUS:85027492633

JO - JACC: Heart Failure

JF - JACC: Heart Failure

SN - 2213-1779

ER -