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Poco LC, Andres EB, Balasubramanian I, Chaudhry I, Malhotra C. Prognostic understanding among advanced heart failure patients and their caregivers: A longitudinal dyadic study. PATIENT EDUCATION AND COUNSELING 2024; 127:108359. [PMID: 38905752 DOI: 10.1016/j.pec.2024.108359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/02/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES To examine heart failure patients' and caregivers' prognostic understanding (PU) over time, and patient and caregiver factors associated with their own and each other's PU. METHODS We used longitudinal dyadic data from Singapore, involving surveys with 95 heart failure patient-caregiver dyads every 4 months for up to 4 years. We assessed the association of PU with patient health status, caregiver psychological distress and caregiving hours using random effects multinomial logistic models, controlling for patient and caregiver characteristics. RESULTS At baseline, half of patients and caregivers reported correct PU. Patient and caregiver variables were associated with their own and each other's PU. Patients with poorer functional well-being were less likely to report correct PU [Average Marginal Effects (95 % CI) 0.008 (0.002, 0.015)] versus incorrect PU. Greater caregiver psychological distress was associated with a lower likelihood of caregivers reporting a correct PU [- 0.008 (-0.014, -0.002)]. Higher caregiving hours reduced the likelihood of patients reporting correct [- 0.002 (-0.003, -0.001)] and increased the likelihood of patients reporting uncertain [0.001 (0, 0.002)] PU. CONCLUSIONS We found PU among patients and caregivers was influenced by their own and each other's experience. Our findings highlight the importance of ongoing communication to enhance PU of patients and caregivers.
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Affiliation(s)
| | | | | | - Isha Chaudhry
- Lien Centre for Palliative Care, Duke-NUS Medical School,169857, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School,169857, Singapore; Health Services and Systems Research, Duke-NUS Medical School, 169857, Singapore.
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2
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Shore S, Harrod M, Vitous A, Silveira MJ, McIlvennan CK, Cascino TM, Langa KM, Ho PM, Nallamothu BK. Prognosis Communication in Heart Failure: Experiences and Preferences of End-Stage Heart Failure Patients and Care Partners. Circ Cardiovasc Qual Outcomes 2024; 17:e010662. [PMID: 38775053 DOI: 10.1161/circoutcomes.123.010662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/22/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Patients with heart failure (HF) overestimate survival compared with model-predicted estimates, but the reasons for this discrepancy are poorly understood. We characterized how patients with end-stage HF and their care partners understand prognosis and elicited their preferences around prognosis communication. METHODS We conducted in-depth, semistructured interviews with patients with end-stage HF and their care partners between 2021 and 2022 at a tertiary care center in Michigan. Participants were asked to describe barriers they faced to understanding prognosis. All interviews were coded and analyzed using an iterative content analysis approach. RESULTS Fifteen patients with end-stage HF and 15 care partners participated, including 7 dyads. The median patient age was 66.5 years (range, 31-80) and included 9 of 15 (60%) White participants and 9 of 15 (60%) were males. Care partners included 10 of 15 (67%) White participants and 6 of 15 (40%) were males. Care partners were partners (n=7, 47%), siblings (n=4, 27%), parents (n=2, 13%), and children (n=2, 13%). Most patients demonstrated a poor understanding of their prognosis. In contrast, care partners commonly identified the patient's rapidly declining trajectory. Patients and care partners described ineffective prognosis communication with clinicians, common barriers to understanding prognosis, and similar suggestions on improving prognosis communication. Barriers to understanding prognosis included (1) conversation avoidance by physicians, (2) information inconsistency across different physicians, (3) distractions during prognosis communication due to emphasis on other conditions, and (4) confusion related to the use of medical jargon. Most patients and care partners wanted discussions around prognosis to begin early in the course of the disease, repeated routinely using layperson's terms, incorporating both quality of life and survival assessments, and involving care partners. Both patients and care partners did not expect precise survival estimates. CONCLUSIONS Patients with end-stage HF demonstrate a poor understanding of their prognosis compared with their care partners. Patients and care partners are open to discussing prognosis early, using direct and patient-centered language.
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Affiliation(s)
- Supriya Shore
- Division of Cardiovascular Disease, Department of Internal Medicine (S.S., T.C., B.K.N.), University of Michigan, Ann Arbor
| | - Molly Harrod
- Center for Clinical Management Research (M.H.), VA Ann Arbor Health Care System, MI
| | - Ann Vitous
- Geriatric Research and Clinical Center (A.V.), VA Ann Arbor Health Care System, MI
| | - Maria J Silveira
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine (M.J.S.), University of Michigan, Ann Arbor
| | - Colleen K McIlvennan
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora (C.K.M.I., P.M.H.)
| | - Thomas M Cascino
- Division of Cardiovascular Disease, Department of Internal Medicine (S.S., T.C., B.K.N.), University of Michigan, Ann Arbor
| | - Kenneth M Langa
- Department of Internal Medicine, Institute for Social Research (K.M.L.), University of Michigan, Ann Arbor
| | - P Michael Ho
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora (C.K.M.I., P.M.H.)
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Disease, Department of Internal Medicine (S.S., T.C., B.K.N.), University of Michigan, Ann Arbor
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3
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Gelfman LP, Blum M, Ogunniyi MO, McIlvennan CK, Kavalieratos D, Allen LA. Palliative Care Across the Spectrum of Heart Failure. JACC. HEART FAILURE 2024; 12:973-989. [PMID: 38456852 DOI: 10.1016/j.jchf.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 03/09/2024]
Abstract
Persons with heart failure (HF) often suffer from poor symptom control, decreased quality of life, and poor communication with their health care providers. These needs are particularly acute in advanced HF, a leading cause of death in the United States. Palliative care, when offered alongside HF disease management, offers improved symptom control, quality of life, communication, and caregiver satisfaction as well as reduced caregiver anxiety. The dynamic nature of the clinical trajectory of HF presents distinct symptom patterns, changing functional status, and uncertainty, which requires an adaptive, dynamic model of palliative care delivery. Due to a limited specialty-trained palliative care workforce, patients and their caregivers often cannot access these benefits, especially in the community. To meet these needs, new models are required that are better informed by high-quality data, engage a range of health care providers in primary palliative care principles, and have clear triggers for specialty palliative care engagement, with specific palliative interventions tailored to patient's illness trajectory and changing needs.
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Affiliation(s)
- Laura P Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; James J. Peters Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center, Bronx, New York, USA.
| | - Moritz Blum
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Modele O Ogunniyi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Grady Health System, Atlanta, Georgia, USA
| | - Colleen K McIlvennan
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Blum M, McKendrick K, Gelfman LP, Pinney SP, Goldstein NE. Using Latent Class Analysis to Identify Different Clinical Profiles Among Patients With Advanced Heart Failure. J Pain Symptom Manage 2023; 65:111-119. [PMID: 36911500 PMCID: PMC9994448 DOI: 10.1016/j.jpainsymman.2022.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Context Although palliative care is guideline-indicated for patients with advanced heart failure (HF), the scarcity of a specialty-trained palliative care workforce demands better identification of patients who are most burdened by the disease. Objectives We sought to identify latent subgroups with variations regarding symptom burden, functional status, and multimorbidity in an advanced HF population. Methods We performed a latent class analysis (LCA) of baseline data from a trial enrolling advanced HF patients. As LCA input variables, we chose indicators of HF severity, physical and psychological symptom burden, functional status, and the number of comorbidities. Results Among 563 patients, two subgroups emerged from LCA, Class A (352 [62.5%]) and Class B (211 [37.5%]). Patients in Class A were less often classified as NYHA class III or IV (88.0% vs. 97.5%, P < 0.001), as compared to Class B patients. Class A patients had fewer symptoms, fewer comorbidities, only 25.9% had impairments in activities of daily living (ADL), and virtually none suffered from clinically significant anxiety (0.4%) or depression (0.9%). In Class B, every patient reported more than three symptoms, almost all patients (92.6%) had some impairment in ADL, and nearly a third had anxiety (30.2%) or depression (28.3%). All-cause mortality after 12 months was higher in Class B, as compared to Class A (18.5% vs. 12.5%, P = 0.047). Conclusion Among advanced HF patients, we identified a distinct subgroup characterized by a conjunction of high symptom burden, anxiety, depression, multimorbidity, and functional status impairment, which might profit particularly from palliative care interventions. J Pain Symptom Manage 2022;000:1-9.
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Affiliation(s)
- Moritz Blum
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Internal Medicine/Cardiology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Karen McKendrick
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura P. Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center (GRECC), Bronx, New York, USA
| | | | - Nathan E. Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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5
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Bernardis A, Gonzalez-Jaramillo V, Ebneter AS, Eychmüller S. Palliative care and COVID-19: a bibliometric analysis. BMJ Support Palliat Care 2023:spcare-2022-004108. [PMID: 36702518 DOI: 10.1136/spcare-2022-004108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To assess the impact of COVID-19 on the palliative care (PC) publication trend in the last 10 years and the collaboration between countries and main topics that were discussed in the papers. METHODS We used Scopus to identify publications on PC between 2012 and 2021 and publications about PC and COVID-19 between 2020 and 2021. We used VOSviewer to assess the main topics using the keywords from the papers and to assess country collaboration. RESULTS 1937 publications resulted. An increase in publications about PC was observed during the pandemic, only partially explained by OVID-19-related publications. Cancer-related PC publications were the ones with the most marked increase. We identified six clusters in the distribution of the keywords: bioethics, cancer, nursing home/telemedicine, public health, caring and PC following the WHO definition. The countries with higher number of publications were the United States and England. CONCLUSION We showed an increase in the number of PC publications in the last 2 years that was only partially explained by COVID-19-related publications. Most of the publications increase was due to cancer-related publications, since, during the time of the pandemic, publications on cancer and PC increased markedly, while those on heart failure, lung disease and dementia, remained constant.
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Affiliation(s)
| | - Valentina Gonzalez-Jaramillo
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Andreas S Ebneter
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Steffen Eychmüller
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
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Teramoto K, Tay WT, Tromp J, Katherine Teng TH, Chandramouli C, Ouwerkerk W, Lawson CA, Huang W, Hung CL, Chopra V, Anand I, Mark Richards A, Lam CSP. Patient-Reported Versus Physician-Assessed Health Status in Heart Failure With Reduced and Preserved Ejection Fraction From ASIAN-HF Registry. Circ Cardiovasc Qual Outcomes 2023; 16:e009134. [PMID: 36484254 DOI: 10.1161/circoutcomes.122.009134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND We aimed to assess if discordance between patient-reported Kansas City Cardiomyopathy Questionnaire (KCCQ)-overall summary (os) score and physician-assessed New York Heart Association (NYHA) class is common among patients with heart failure (HF) with reduced or preserved ejection fraction, and determine its association with outcomes. METHODS A total of 4818 patients with HF were classified according to KCCQ-os score (range 0-100, dichotomized by median value 71.9 into high [good] versus low [bad]) and NYHA class (I/II [good] or III/IV [bad]) as concordant good (low NYHA class, high KCCQ-os score), concordant bad (high NYHA class, low KCCQ-os score), discordant worse NYHA class (high NYHA class, high KCCQ-os score), and discordant worse KCCQ-os score (low NYHA class, low-KCCQ-os score). The composite of HF hospitalization or death at 1 year was compared across groups. RESULTS There were 2070 (43.0%) concordant good, 1099 (22.8%) concordant bad, 331 (6.9%) discordant worse NYHA class, and 1318 (27.4%) discordant worse KCCQ-os score patients. Compared with concordant good, adverse outcomes were the highest in concordant bad (HR, 2.7 [95% CI, 2.2-3.5]) followed by discordant worse KCCQ-os score (HR, 1.8 [95% CI, 1.4-2.2]) and discordant worse NYHA class (HR, 1.5 [95% CI, 1.0-2.3]); with no modification by HF phenotype (preserved versus reduced ejection fraction, Pinteraction=0.52). At 6 months, 1403 (48%) experienced clinically significant improvement in KCCQ-os score (≥5 points increase over 6 months). Patients with improved KCCQ-os at 6 months (HR, 0.65 [95% CI, 0.47-0.92]) had better outcomes and the association was not modified by HF phenotype (Pinteraction=0.40). CONCLUSIONS One-third of patients with HF had discordance between patient-reported and clinician-assessed health status, largely attributable to worse patient-reported outcomes. Such discordance, particularly in those with discordantly worse KCCQ, should alert physicians to an increased risk of HF hospitalization and death, and prompt further assessment for potential drivers of worse patient-reported outcomes relative to physicians' assessment.
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Affiliation(s)
- Kanako Teramoto
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,National Cerebral and Cardiovascular Center, Osaka, Japan (K.T.)
| | - Wan Ting Tay
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.)
| | - Jasper Tromp
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,Saw Swee Hock School of Public Health National University of Singapore and the National University Health System (J.T.)
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,School of Allied Health, University of Western Australia, Perth, Australia (T.-H.K.T.)
| | - Chanchal Chandramouli
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,Duke-NUS Medical School, Singapore (J.T., T.-H.K.T., C.C., C.S.P.L.)
| | - Wouter Ouwerkerk
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,Amsterdam Medical Center, Department of Dermatology, The Netherlands (W.O.)
| | - Claire A Lawson
- Department of Cardiovascular Research, University of Leicester, United Kingdom (C.A.L.)
| | - Weiting Huang
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.)
| | | | - Vijay Chopra
- Max Super Specialty Hospital, New Delhi, India (V.C.)
| | - Inder Anand
- Cardiovascular division, University of Minnesota, Minneapolis (I.A.)
| | - Arthur Mark Richards
- Cardiovascular Research Institute, National University of Singapore (A.M.R.).,Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.)
| | - Carolyn S P Lam
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,Duke-NUS Medical School, Singapore (J.T., T.-H.K.T., C.C., C.S.P.L.).,Department of Cardiology, University Medical Center Groningen, The Netherlands (C.S.P.L.)
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Fukue N, Naito E, Kimura M, Ono K, Sato S, Takaki A, Ikeda Y. Readiness of Advance Care Planning Among Patients With Cardiovascular Disease. Front Cardiovasc Med 2022; 9:838240. [PMID: 35722131 PMCID: PMC9205245 DOI: 10.3389/fcvm.2022.838240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Advance care planning (ACP) is a widely advocated strategy to improve outcomes at end-of-life care for patients suffering from heart failure (HF). However, finding the right time to start ACP is challenging for healthcare providers because it is often a sensitive issue for patients with HF and their families. We interviewed patients with cardiovascular diseases regarding ACP readiness and investigated the relationship between the ACP desire and multiple clinical prognostic parameters. Method Eighty-one patients (average age 81.8 ± 10.3 years old, 42 men, 62 cases of HF) who introduced cardiac rehabilitation were inquired about previous ACP experience, a desire for ACP, understanding of their cardiovascular diseases, and lifestyle-associated questionnaires. Multiple logistic regression analyses were employed to identify the clinical parameters associated with ACP desire. Patients who desired ACP were also asked about their preferences for medical care at the end-of-life. Results Nine patients (11.1%) had previous experience with ACP, and 28 (34.6%) preferred to implement ACP. Patients who did not want to implement ACP were 54.3%. Patients with HF showed a higher acceptance rate of ACP (odds ratio [OR] 5.56, p = 0.015). Interestingly, patients harboring skeletal muscle frailty showed lower ACP acceptance, while patients with non-frailty rather positively wanted to implement ACP. Two types of prognosis evaluation scales, such as the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) risk score and the Japanese Version of Supportive and Palliative Care Indicators Tool (SPICT-JP), identified 31 patients (38.3%) needing ACP; however, 19 (61.3%) did not want ACP. The wish not to attempt resuscitation and life-prolonging treatment at the end-of-life reached approximately 70% among patients who requested ACP. Conclusions Although patients with HF tended to be ready for implementing ACP, the presence of skeletal muscle frailty was negatively associated with ACP preference. Indeed, patients who should be considered ACP were not carried out and did not desire it. Earlier introduction of ACP into patients before having skeletal muscle frailty may be considered.
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Affiliation(s)
- Noriko Fukue
- Department of Cardiology, Tokuyama Medical Association Hospital, Shunan, Japan
- Department of Cardiology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
- *Correspondence: Noriko Fukue
| | - Emiko Naito
- Nursing Department, Tokuyama Medical Association Hospital, Shunan, Japan
| | - Masayasu Kimura
- Department of Cardiology, Tokuyama Medical Association Hospital, Shunan, Japan
| | - Kaoru Ono
- Department of Cardiology, Tokuyama Medical Association Hospital, Shunan, Japan
| | - Shinichi Sato
- Department of Cardiology, Tokuyama Medical Association Hospital, Shunan, Japan
| | - Akira Takaki
- Department of Cardiology, Tokuyama Medical Association Hospital, Shunan, Japan
| | - Yasuhiro Ikeda
- Department of Cardiology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
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8
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Blum M, Gelfman LP, McKendrick K, Pinney SP, Goldstein NE. Enhancing Palliative Care for Patients With Advanced Heart Failure Through Simple Prognostication Tools: A Comparison of the Surprise Question, the Number of Previous Heart Failure Hospitalizations, and the Seattle Heart Failure Model for Predicting 1-Year Survival. Front Cardiovasc Med 2022; 9:836237. [PMID: 35479267 PMCID: PMC9035562 DOI: 10.3389/fcvm.2022.836237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Score-based survival prediction in patients with advanced heart failure (HF) is complicated. Easy-to-use prognostication tools could inform clinical decision-making and palliative care delivery. Objective To compare the prognostic utility of the Seattle HF model (SHFM), the surprise question (SQ), and the number of HF hospitalizations (NoH) within the last 12 months for predicting 1-year survival in patients with advanced HF. Methods We retrospectively analyzed data from a cluster-randomized controlled trial of advanced HF patients, predominantly with reduced ejection fraction. Primary outcome was the prognostic discrimination of SHFM, SQ (“Would you be surprised if this patient were to die within 1 year?”) answered by HF cardiologists, and NoH, assessed by receiver operating characteristic (ROC) curve analysis. Optimal cut-offs were calculated using Youden’s index (SHFM: <86% predicted 1-year survival; NoH ≥ 2). Results Of 535 subjects, 82 (15.3%) had died after 1-year of follow-up. SHFM, SQ, and NoH yielded a similar area under the ROC curve [SHFM: 0.65 (0.60–0.71 95% CI); SQ: 0.58 (0.54–0.63 95% CI); NoH: 0.56 (0.50–0.62 95% CI)] and similar sensitivity [SHFM: 0.76 (0.65–0.84 95% CI); SQ: 0.84 (0.74–0.91 95% CI); NoH: 0.56 (0.45–0.67 95% CI)]. As compared to SHFM, SQ had lower specificity [SQ: 0.33 (0.28–0.37 95% CI) vs. SHFM: 0.55 (0.50–0.60 95% CI)] while NoH had similar specificity [0.56 (0.51–0.61 95% CI)]. SQ combined with NoH showed significantly higher specificity [0.68 (0.64–0.73 95% CI)]. Conclusion SQ and NoH yielded comparable utility to SHFM for 1-year survival prediction among advanced HF patients, are easy-to-use and could inform bedside decision-making.
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Affiliation(s)
- Moritz Blum
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- *Correspondence: Moritz Blum,
| | - Laura P. Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- James J. Peters Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center, Bronx, NY, United States
| | - Karen McKendrick
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sean P. Pinney
- Department of Medicine, University of Chicago Medicine, Chicago, IL, United States
| | - Nathan E. Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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9
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Straw S, McGinlay M, Gierula J, Witte KK. We Do Not Talk to Patients About Their Prognosis, But Is Any of This Surprising? J Card Fail 2021; 27:1479-1480. [PMID: 34324925 DOI: 10.1016/j.cardfail.2021.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Sam Straw
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Melanie McGinlay
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Universitaetsklinikum, RWTH, Aachen, Germany.
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