OBJECTIVES: This study was designed to analyze how patient preferences for survival versus quality-of-life change after hospitalization with advanced heart failure (HF). BACKGROUND: Although patient-centered care is a priority, little is known about preferences to trade length of life for quality among hospitalized patients with advanced HF, and it is not known how those preferences change after hospitalization. METHODS: The time trade-off utility, symptom scores, and 6-min walk distance were measured in 287 patients in the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheter Effectiveness) trial at hospitalization and again during 6 months after therapy to relieve congestion. RESULTS: Willingness to trade was bimodal. At baseline, the median trade for better quality was 3 months' survival time, with a modest relation to symptom severity. Preference for survival time was stable for most patients, but increase after discharge occurred in 98 of 145 (68%) patients initially willing to trade survival time, and was more common with symptom improvement and after therapy guided by pulmonary artery catheters (p = 0.034). Adjusting days alive after hospital discharge for patients' survival preference reduced overall days by 24%, with the largest reduction among patients dying early after discharge (p = 0.0015). CONCLUSIONS: Preferences remain in favor of survival for many patients despite advanced HF symptoms, but increase further after hospitalization. The bimodal distribution and the stability of patient preference limit utility as a trial end point, but support its relevance in design of care for an individual patient.
OBJECTIVES: This study was designed to analyze how patient preferences for survival versus quality-of-life change after hospitalization with advanced heart failure (HF). BACKGROUND: Although patient-centered care is a priority, little is known about preferences to trade length of life for quality among hospitalized patients with advanced HF, and it is not known how those preferences change after hospitalization. METHODS: The time trade-off utility, symptom scores, and 6-min walk distance were measured in 287 patients in the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheter Effectiveness) trial at hospitalization and again during 6 months after therapy to relieve congestion. RESULTS: Willingness to trade was bimodal. At baseline, the median trade for better quality was 3 months' survival time, with a modest relation to symptom severity. Preference for survival time was stable for most patients, but increase after discharge occurred in 98 of 145 (68%) patients initially willing to trade survival time, and was more common with symptom improvement and after therapy guided by pulmonary artery catheters (p = 0.034). Adjusting days alive after hospital discharge for patients' survival preference reduced overall days by 24%, with the largest reduction among patients dying early after discharge (p = 0.0015). CONCLUSIONS: Preferences remain in favor of survival for many patients despite advanced HF symptoms, but increase further after hospitalization. The bimodal distribution and the stability of patient preference limit utility as a trial end point, but support its relevance in design of care for an individual patient.
Authors: E A Rose; A C Gelijns; A J Moskowitz; D F Heitjan; L W Stevenson; W Dembitsky; J W Long; D D Ascheim; A R Tierney; R G Levitan; J T Watson; P Meier; N S Ronan; P A Shapiro; R M Lazar; L W Miller; L Gupta; O H Frazier; P Desvigne-Nickens; M C Oz; V L Poirier Journal: N Engl J Med Date: 2001-11-15 Impact factor: 91.245
Authors: Edward P Havranek; Teresa A Simon; Gilbert L'Italien; Allison Smitten; A Brett Hauber; Roland Chen; Pablo Lapuerta Journal: J Card Fail Date: 2004-08 Impact factor: 5.712
Authors: Cynthia Binanay; Robert M Califf; Vic Hasselblad; Christopher M O'Connor; Monica R Shah; George Sopko; Lynne W Stevenson; Gary S Francis; Carl V Leier; Leslie W Miller Journal: JAMA Date: 2005-10-05 Impact factor: 56.272
Authors: P Jaagosild; N V Dawson; C Thomas; N S Wenger; J Tsevat; W A Knaus; R M Califf; L Goldman; H Vidaillet; A F Connors Journal: Arch Intern Med Date: 1998-05-25
Authors: Jeffrey J Teuteberg; Eldrin F Lewis; Anju Nohria; Sui W Tsang; James C Fang; Michael M Givertz; John A Jarcho; Gilbert H Mudge; Kenneth L Baughman; Lynne W Stevenson Journal: J Card Fail Date: 2006-02 Impact factor: 5.712
Authors: Soko Setoguchi; Robert J Glynn; Margaret Stedman; Carol M Flavell; Raisa Levin; Lynne Warner Stevenson Journal: Am Heart J Date: 2010-07 Impact factor: 4.749
Authors: Suzanne V Arnold; Khaja M Chinnakondepalli; John A Spertus; Elizabeth A Magnuson; Suzanne J Baron; Saibal Kar; D Scott Lim; Jacob M Mishell; William T Abraham; JoAnn A Lindenfeld; Michael J Mack; Gregg W Stone; David J Cohen Journal: J Am Coll Cardiol Date: 2019-03-17 Impact factor: 24.094
Authors: Nancy Luo; Joseph G Rogers; Gwen C Dodson; Chetan B Patel; Anthony N Galanos; Carmelo A Milano; Christopher M O'Connor; Robert J Mentz Journal: Am J Cardiol Date: 2016-06-21 Impact factor: 2.778
Authors: Sandesh Dev; Robert M Clare; G Michael Felker; Mona Fiuzat; Lynne Warner Stevenson; Christopher M O'Connor Journal: Eur J Heart Fail Date: 2011-10-27 Impact factor: 15.534
Authors: Ruth Ann Marrie; Charles N Bernstein; Christine A Peschken; Carol A Hitchon; Hui Chen; Randy Fransoo; Allan Garland Journal: Neurology Date: 2014-05-07 Impact factor: 9.910
Authors: Marco Metra; John R Teerlink; G Michael Felker; Barry H Greenberg; Gerasimos Filippatos; Piotr Ponikowski; Sam L Teichman; Elaine Unemori; Adriaan A Voors; Beth Davison Weatherley; Gad Cotter Journal: Eur J Heart Fail Date: 2010-08-22 Impact factor: 15.534
Authors: Peter S Pang; Sean P Collins; Kori Sauser; Adin-Cristian Andrei; Alan B Storrow; Judd E Hollander; Miguel Tavares; Jindrich Spinar; Cezar Macarie; Dimitar Raev; Richard Nowak; Mihai Gheorghiade; Alexandre Mebazaa Journal: Acad Emerg Med Date: 2014-06 Impact factor: 3.451