TUESDAY, June 3, (HealthDay News) -- For reasons not easily
understood, many patients with the worst type of heart disease
think they will live longer than their doctors tell them they will,
new research shows.
Very carefully, cardiologists at Duke University began telling
people being treated for heart failure -- the progressive loss of
ability to pump blood -- that the condition would shorten their
lives. They weren't believed.
Instead, many patients preferred to believe that they would have
the normal life span expected of men their age, according to a
report on this unusual bit of research, published in the June 4
issue of the
Journal of the American Medical Association.
Life expectancy for people with heart failure is on average as
bad or worse than for patients with cancer, said study author Dr.
Larry A. Allen, a clinical instructor in cardiology. "The
expectation is just four to five years with symptomatic heart
failure, and those we see in the specialty clinic do even worse,"
he said.
It's hard for most people to face the truth about heart failure.
"My general impression is that many of these patients don't
comprehend how serious their illness is and how it might affect
their survival," Allen said.
According to U.S. government statistics, about 5 million people
in the United States have heart failure, and it results in about
300,000 deaths each year.
Pressing home the truth is important because "misperceptions
about survival can hinder patients from making rational decisions
about medical therapy and the end of life," Allen said.
So, he and his colleagues used the somewhat new Seattle Heart
Failure Model to make predictions about 122 people being treated
for heart failure, and to tell them the life span predicted by the
model, which gives a fairly detailed description of what a heart
failure patient can expect.
On average, the model predicted each person could expect 10 more
years of life. Sixty-three percent of the people in the trial
differed with that outlook, estimating an average of 13 more years
ahead.
The researchers followed those people for three and a half years
and found that the Seattle Heart Failure Model predictions were
indeed accurate. "They even died at a slightly higher rate than
predicted," Allen said.
Such information must be handled with great care, he said.
"Obviously it needs to be carefully and gently explained to
people," Allen said. "But if they understand what the range of
prognoses will be for them, they can make more rational decisions
about care."
Predictions could even improve lives, he said. "I certainly
think we can improve life expectancy," Allen said. "We can motivate
them to make good decisions about health care."
But caution is required, said Dr. Clyde W. Yancy, medical
director of the Baylor Heart and Vascular Institute in Dallas, who
wrote an accompanying editorial.
"This is one area where we need very precise tools so that we
don't make mistakes," Yancy said. "If a mistake is made, it should
be longer rather than shorter, so that we hold out hope as long as
possible."
There are still some refinements to be made in the Seattle
model, prepared at the University of Washington, Yancy said. Nearly
half the people in the Duke study were black, and "there were no
such candidates in Seattle," he said.
And then there is the difficulty that physicians face in talking
about shortened life spans, he said. "We physicians are not
equipped with communication skills in that area," Yancy said.
"Extending our discussions to a quantitative dialogue requires
tools that we have not yet refined."
More information
Learn about heart failure and its consequences from the U.S.
National Heart, Lung, and Blood Institute.
