Wayne Kuznar
22 dec 2008--Longevity trumps quality of life for most older patients with heart failure, found Hans Peter Brunner-La Rocca, MD, in his study of end-of-life preferences of patients 60 years or older with heart failure.
Before the study, it had been assumed that older patients with chronic diseases would choose quality of life over prolonged survival, but this assumption had never been investigated properly, particularly in older patients with chronic HF, said Dr. Brunner-La Rocca, professor of cardiology, University Hospital Basel, Switzerland.
End-of-life preferences and quality of life was assessed using standardized questionnaires administered to 622 patients 60 to 97 years old who had been hospitalized within the previous year for chronic HF. The average age of the patients was 77 years.
One tool called a time trade-off instrument asked patients their willingness to accept a shorter life span (an assumed survival of 2 years) for living without symptoms. Of the 555 patients who replied to this question, 74% said they would not have been willing to trade survival time for enhanced quality of life.
"Personally, I was quite impressed and surprised by these findings," said Dr. Brunner-La Rooca. "We actually expected the opposite."
A willingness to trade time for a higher quality of life was greater in patients with New York Heart Association class III or higher (P = .03), a lower level of hemoglobin (P = .003), a higher score on depression scales (P = .002), and those living alone (P = .004). Even among these groups, the difference in the percentage willing to trade survival for quality of life and those not willing to make the trade was "quite small," he said. "We can't really say from the predictors that we can predict what an individual patient wants."
Six hundred three patients expressed a resuscitation preference; 51% wanted resuscitation, 39% did not, and 10% were undetermined.
He hopes that these findings foster individual discussions between physicians and patients regarding the aim of therapy with respect to end-of-life preferences.
The findings were presented at the American Heart Association Scientific Sessions 2008 in New Orleans in November.
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