Changing preferences for survival after hospitalization with advanced heart failure
Open accessAbstract
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.
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Factors associated with willingness to trade time included symptom severity and a higher depression score within the Minnesota Living with Heart Failure Questionnaire.
“Factors associated with willingness to trade time included symptom severity and a higher depression score within the Minnesota Living with Heart Failure Questionnaire (MLHFQ).”
From Prioritizing symptom management in the treatment of chronic heart failure (2020) · cites this paper as [16]
The Results (Time Trade-Off Distribution; page unavailable) relate symptom severity to the amount of time patients would trade and report an association between the MLHF depression item and time-trade-off values. The passage does not specify that higher depression scores were associated with greater willingness to trade time. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn the ESCAPE trial, shortly after discharge, more than half of 287 patients were willing to trade survival time for improved symptom control.
“The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial 16 interviewed 287 patients from initial hospitalization until 6 months of post‐admission revealing that shortly after discharge, more than half were willing to trade survival time for improved symptom control”
From Prioritizing symptom management in the treatment of chronic heart failure (2020) · cites this paper as [16]
The Methods and Results describe time-trade-off assessments in the ESCAPE trial, including follow-up for 287 patients over six months. The Results report a median willingness to trade three months at baseline, during hospitalization, but do not establish that more than half of the 287 patients were willing to trade survival time shortly after discharge. (LLM, conf=0.85)
Experimental — accuracy not yet measuredOnce symptoms had stabilized beyond 6 months, the majority (68%) of ESCAPE patients prioritized survival.
“but once their symptoms had stabilized beyond 6 months, the majority (68%) prioritized survival.”
From Prioritizing symptom management in the treatment of chronic heart failure (2020) · cites this paper as [16]
The Abstract Results report that 98 of 145 patients (68%) who were initially willing to trade survival time increased their preference for survival after discharge. That is not 68% of all ESCAPE patients, nor does it establish their preferences beyond six months; the Methods describe follow-up during the six months after discharge. The Results on functional status associate increased survival preference with symptom improvement, but do not say symptoms had stabilized before that change. (LLM, conf=0.88)
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- Authors
- Stevenson, L. W., Hellkamp, A. S., Leier, C. V., Sopko, G., Koelling, T., Warnica, J. W., Abraham, W. T., Kasper, E. K., Rogers, J. G., Califf, R. M., Schramm, E. E., & O'Connor, C. M.
- Affiliations
- Brigham and Women's Hospital (US)
- Duke University (US)
- The Ohio State University Wexner Medical Center (US)
- National Institutes of Health (US)
- University of Michigan (US)
- University of Calgary (CA)
- Johns Hopkins University (US)
- Corresponding author
- Stevenson, Lynne W.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2008-11
- Volume
- 52
- Issue
- 21
- Pages
- 1702-1708
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC2763302
- OpenAlex
- W2054854416
- Cited by
- 164
- References
- 16
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 3 · 2023: 13 · 2022: 9 · 2021: 4 · 2020: 14 · 2019: 6 · 2018: 4 · 2017: 8 · 2016: 13 · 2015: 13 · 2014: 8 · 2013: 11 · 2012: 7
- FWCI
- 7.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hv098177-001)
- National Heart, Lung, and Blood Institute (N01 HV 98177, N01 HV098177)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- advanced heart failure, patient preferences, pulmonary artery catheter, symptom severity, 6-minute walk distance, trial end points, patient-centered care, ESCAPE trial
- MeSH terms
- Activities of Daily Living, Aged, Attitude to Death, Catheterization, Swan-Ganz, Continuity of Patient Care, Female, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Monitoring, Physiologic, Probability, Prognosis, Quality of Life, Surveys and Questionnaires, Severity of Illness Index, Time Factors, Cohort Studies, Critical Illness, Patient Satisfaction, Quality-Adjusted Life Years
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