Prognostic Understanding and Preference for the Communication Process with Physicians in Hospitalized Heart Failure Patients.

Abstract Background Heart failure (HF) is a highly prevalent, heterogeneous, and life-threatening condition. Precise prognostic understanding is essential for effective decision-making, but little is known about patients’ attitudes toward prognostic communication with their physicians. Methods and Results We conducted a questionnaire survey, consisting of patients’ prognostic understanding, preferences for information disclosure, and depressive symptoms, among hospitalized HF patients (92 items in total). Individual 2-year survival rates were calculated using the Seattle Heart Failure Model (SHFM), and its agreement level with patient self-expectations of 2-year survival were assessed. A total of 113 patients completed the survey (male 65.5%, median age 75.0 [66.0–81.0] years). Compared to the SHFM-prediction, patient-expectation of 2-year survival was matched only in 27.8%; their agreement level was low (weighted kappa = 0.11). Notably, 50.9% wished to know “more,” albeit 27.7% felt that they did not have adequate prognostic discussion. Compared to the known prognostic variables (e.g. age and HF severity), logistic regression analysis demonstrated that female and less depressive patients were associated with patients’ preference for “more” prognostic discussion. Conclusions Patients’ overall prognostic understanding was suboptimal. The communication process requires further improvement for patients to accurately understand their HF prognosis and be involved in making a better-informed decision.