Determinants of Preferences in Heart Failure Patients

描述（由申请人提供）：心力衰竭（HF）影响470万美国人，尽管最近治疗取得了进展，但其死亡率和发病率很高。在晚期心衰患者中，生活质量（QOL）通常与生存时间一样重要。这些患者通常面临着艰难的决定，如高风险的瓣膜手术、血运重建术和左心室辅助装置。当最优治疗存在不确定性时，患者的偏好应该发挥更大的作用。我们假设充填压力升高的患者将更愿意承担风险或牺牲时间来获得更好的健康。此外，强化住院治疗与充填压力的改善将改善患者的偏好。心衰患者将完成几个工具，包括时间权衡和标准赌博工具，以评估患者的偏好。充盈压力的估计将通过体格检查、脑利钠肽水平和详细的超声心动图研究来实现。研究对象的填充压力指标将与他们的生活质量和偏好得分进行比较。这种血流动力学与偏好的相关性有可能提高生活质量评估的临床应用，影响困难决策的方法，并确定改善生活质量的新方法。

DESCRIPTION (provided by applicant): Heart failure (HF) affects 4.7 million Americans with a high mortality and morbidity despite recent therapeutic advances. In advanced HF patients, quality of life (QOL) is often as important as duration of life. These patients often are faced with difficult decisions such as high-risk valve surgery, revascularization, and left ventricular assist devices. The preferences of patients should play an even larger role when uncertainty exists about the most optimal therapy. We postulate that patients with elevated filling pressures will be more willing to take risks or trade time to achieve better health. Furthermore, intensive inpatient therapy with an improvement in filling pressures will improve patient preferences. Subjects with HF will complete several tools, including the time trade-off and standard gamble instrument to assess patient preferences. Estimates of filling pressures will be achieved by physical exam, brain natriuretic peptide level, and a detailed echocardiographic study. Indices of filling pressures of study subjects will be compared with their QOL and preference scores. Such correlations of hemodynamics with preferences have the potential to improve the clinical utility of QOL assessment, affect the approach to difficult decision-making, and identify novel approaches for improving QOL.