Determinants of Preferences in Heart Failure Patients

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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.