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Posted: June 10, 2008

Heart Failure Patients Often in Denial on Life Expectancy

While heart disease patients don’t feel they will live forever, they do tend to believe they will live longer than their doctors caution them they will, according to a study by Duke University cardiologists.

Now, medical experts are trying to understand why those with the worst type of heart disease take this overly optimistic attitude.

The findings grew out of research by Duke doctors who said they very carefully began telling patients diagnosed with heart failure that the condition would definitely shorten their lives.

Despite the doctor warnings, many patients insisted on a belief that they would have the normal life span expected of people their age.

Heart failure is an extremely serious condition. It occurs when a patient progressively loses the ability to pump blood through the heart and eventually dies. About 5 million Americans currently suffer from heart failure, and the disease claims about 300,000 lives each year. In fact, life expectancy for those with heart failure is on average equally poor or worse than for cancer patients.

"The expectation is just four to five years [of life] with symptomatic heart failure, and those we see in the specialty clinic do even worse," said Dr. Larry A. Allen, a clinical instructor in cardiology at Duke and the study’s author. Allen and colleagues’ research was published in the Journal of the American Medical Association.

Yet many of those tracked in the Duke project refused to “hear” the caution. "My general impression is that many of these patients don't comprehend how serious their illness is and how it might affect their survival," Allen told the Health Day news service.

Allen said that based on his findings, the Duke team is strenuously in favor of providing an unmistakable message to heart failure patients about their remaining life expectancy because "misperceptions about survival can hinder patients from making rational decisions about medical therapy and the end of life."

In their testing the researchers used the Seattle Heart Failure Model to predict life expectancy for about 122 people they were treating for heart failure, and to tell them their predicted life span. On average, the model predicted each person could expect 10 more years of life. However, 63% of those in the trial differed with that prediction. Instead, on average, they estimated their remaining lifespan to be 13 more years.

The researchers followed those people for three and a half years and found that the Seattle Heart Failure Model predictions were indeed accurate. "They even died at a slightly higher rate than predicted," Allen told Health Day.

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