Changing Preferences for Survival After Hospitalization With Advanced Heart Failure (original) (raw)

2008, Journal of the American College of Cardiology

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-minute walk were measured at hospitalization and again in 287 patients during 6 months after therapy to relieve congestion in the ESCAPE trial. Results-Willingness to trade was bimodal. At baseline, the median trade for better quality was 3 months survival time, with modest relation to symptom severity. Preference for survival time was stable for most patients, but increase after discharge occurred in 98/145(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 out of hospital for patients' survival preference reduced overall days by 24%, with largest reduction in patients dying early after discharge (p=0.0015).