Study Shows Patients Overestimate Their Life Expectancy June 3, 2008 -- Many people with heart failure may be overly optimistic when it comes to estimating how long they have left to live. A new study shows nearly two-thirds of people with congestive heart failure overestimate their remaining life expectancy by an average of 40% compared with what's realistic based on their prognosis. Heart
failure, which occurs when the heart is too weak to pump enough blood to meet the body's needs, causes 55,000 deaths each year and indirectly contributes to 230,000 more deaths annually in the U.S. Although there have been recent improvements in congestive heart failure
treatment, researchers say the prognosis for people with the disease is still bleak, with about 50% having an average life expectancy of less than five years. For those with advanced forms of heart failure, nearly 90% die within one year. "Patient perception of prognosis is important because it fundamentally influences medical decision making regarding medications, devices,
transplantation, and end-of-life care," write researcher Larry A. Allen, MD, MHS, of the Duke Clinical Research Institute and colleagues in The Journal of the American Medical Association. In the study, researchers surveyed 122 people (average age 62) with moderate to advanced congestive heart failure about their perception of their life expectancy. They found the heart failure
patients tended to overestimate their life expectancy by about three years. The average patient survival estimate was 13 years compared with a validated medical model estimate of 10 years. Overall, 63% of people with heart failure overestimated their remaining life expectancy by an average of 40% compared with medical model predictions. Those who were younger and with more advanced disease were most likely to overestimate how long they had left to live. During the three-year
follow-up period, 29% of the people involved in the survey died. Researchers found no relationship between longer life expectancy perceptions and survival. "The exact reasons for this incongruity are unknown but they may reflect hope or may result from inadequate
communication between clinicians and their patients about prognosis," write the researchers. "Because differences in expectations about prognosis could affect decision making regarding advanced therapies and end-of-life planning, further research into both the extent and the underlying causes of these differences is warranted." In an editorial that accompanies the study, Clyde W. Yancy, MD, of Baylor University Medical Center in Dallas, writes that predicting life
expectancy in people with heart failure is not an exact science and many questions remain about clinical prediction models. Therefore, until these issues are fully addressed, people should embrace an individualized decision-making process regarding end-of-life care guided by physician input.  Ever wondered why heart and kidney diseases often go together? Dr Paul Kalra, consultant cardiologist at Queen Alexandra Hospital, Portsmouth, talks to Judy O’Sullivan about how our vital organs interact. Imagine there’s been an accident on one of the motorways linking some of the UK’s major cities. It’s rarely just the one road that’s affected – a traffic jam on one major route often leads to congestion on others. The same is true for your body. Think of your vital organs as key cities linked together by a network of motorways and main roads – the arteries and veins. When there’s a problem in one, things often go wrong elsewhere. This is especially true of the heart and kidneys, which work very closely together. How they work togetherThe heart’s job is to send a continuous supply of oxygenated blood around the body. The kidney filters the blood, extracting waste in the form of urine, and also helps regulate the water and salt levels to control blood pressure.
Relatively recent research has shown that heart failure is a significant risk factor for kidney disease. When the heart is no longer pumping efficiently it becomes congested with blood, causing pressure to build up in the main vein connected to the kidneys and leading to congestion of blood in the kidneys, too. The kidneys also suffer from the reduced supply of oxygenated blood. When the kidneys become impaired, the hormone system, which regulates blood pressure, goes into overdrive in an attempt to increase blood supply to the kidneys. The heart then has to pump against higher pressure in the arteries, and eventually suffers from the increase in workload. It’s routine for doctors to check your kidney function if they believe you may have heart disease. A simple blood test can check if the level of creatinine, a waste product usually secreted by the kidneys, is raised, suggesting impairment. Some patients may also need an ultrasound or CT scan to help examine their kidneys’ structure and function. Can it be treated?Combined heart and kidney disease is usually treated with several drugs. Control of high blood pressure is key. Water tablets, or diuretics, help reduce blood pressure and remove excess fluid as they make the kidneys excrete more water and salt. Swollen ankles are a common indication of excess fluid: talk to your doctor if this keeps happening to you. Other drugs include ace inhibitors (ramipril, enalapril, lisinopril, perindopril), beta blockers (bisoprolol, carvedilol, nebivolol) and aldosterone blockers (spironolactone, eplerenone). These all benefit patients with heart failure as they counteract the over-activation of the hormone system. However, they can have a negative effect on the kidneys so it takes careful monitoring and frequent blood tests to get the balance right. How you can reduce your risk:
Meet the expertHe has a clinical and academic interest in patients with cardio-renal disease. He was co-organiser of the UKs first national Cardio-Renal Conference in 2006; this has now developed into a very successful annual meeting with around 150 delegates. He edited ‘Specialist Training in Cardiology’ which was Highly Commended in the 2006 BMA Medical Book Competition. What happens when you have kidney failure and heart failure?When the kidneys don't work well, more stress is put on the heart. When someone has CKD, their heart needs to pump harder to get blood to the kidneys. This can lead to heart disease, the leading cause of death in the United States. Change in blood pressure is also a CKD complication that can lead to heart disease.
Can you survive kidney and heart failure?Main results: CHF patients progressing to dialysis- dependent renal failure had a grave prognosis: median survival time was 95 days, mean survival 444 days. None of the known factors except age was associated with a worse outcome in CHF patients.
How long can you live with renal heart failure?Most people with end-stage heart failure have a life expectancy of less than 1 year. 4. The leading causes of heart failure are diseases that damage the heart, such as heart disease, high blood pressure, and diabetes.
What are the final stages of heart failure?Patients in the end stages of heart failure want to know what to expect. The symptoms of end-stage congestive heart failure include dyspnea, chronic cough or wheezing, edema, nausea or lack of appetite, a high heart rate, and confusion or impaired thinking.
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How long can you live with kidney and heart failure
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