Changing preferences for survival after hospitalization with advanced heart failure.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Stevenson, LW; Hellkamp, AS; Leier, CV; Sopko, G; Koelling, T; Warnica, JW; Abraham, WT; Kasper, EK; Rogers, JG; Califf, RM; Schramm, EE; O'Connor, CM

Published Date

  • November 18, 2008

Published In

Volume / Issue

  • 52 / 21

Start / End Page

  • 1702 - 1708

PubMed ID

  • 19007689

Pubmed Central ID

  • PMC2763302

Electronic International Standard Serial Number (EISSN)

  • 1558-3597

Digital Object Identifier (DOI)

  • 10.1016/j.jacc.2008.08.028


  • eng

Conference Location

  • United States