AJM: We cant predict mortality in patients with heart failure

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Less than one-fourth of physicians specializing in geriatrics, internal, family medicine or cardiology believe they can accurately predict whether patients with heart failure are at risk of dying, according to new research completed at Saint Louis University.

The ability to determine whether patients are within six months of death is crucial to clinical care, impacting key patient-care decisions, such as therapeutic approaches and referral for palliative care,  researchers said.

“Our findings are important not only in light of the increasing prevalence of heart failure in the United States but because the data show that there are considerable gaps in knowledge regarding end-stage heart failure that ultimately affect a patient’s experience with their illness,” says lead author Paul Hauptman, MD, professor of internal medicine at SLU School of Medicine.

“Unlike cancer, for example, predicting death is not always clear with end-stage heart failure,” he said.

This study will provide valuable insight into physicians’ beliefs and biases in regards to end-stage heart failure, Hauptman said.

“This area has not been previously explored, but is essential if we are to design interventions to help physicians select appropriate care options for their patients,” he added.

Using a random stratified survey, 1,450 physicians (600 cardiologists, 300 geriatricians and 300 internal and family medicine doctors), were polled for the study, and approximately 60% of physicians polled responded to the survey.

Across the board, physicians reported that they were unlikely to refer a patient with end-stage heart failure for hospice care. Their reluctance was partly due to uncertainty about timing and patient acceptance of the recommendation

The study also provides insight into existing knowledge gaps regarding appropriate monitoring of patients and selection of management options. For example, very few physicians ask patients to complete quality-of-life questionnaires or objectively measure functional status, two key factors that help determine a patient’s status, according to the authors.

The study also found that doctors rarely discuss deactivating ICDs with very sick heart failure patients and their families. While the majority of physicians surveyed agreed that deactivating the device is appropriate with end-stage heart failure, very few heed this advice, the researchers reported.

The National Institute on Aging of the National Institute for Health funded the study, and the complete findings were published in the February 2008 issue of The American Journal of Medicine.