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，尽管最近的治疗进展，但其死亡率和发病率很高。在晚期HF患者中，生活质量（QOL）通常与生命持续时间一样重要。这些患者经常面临困难的决定，如高风险的瓣膜手术，血运重建和左心室辅助装置。当最佳治疗存在不确定性时，患者的偏好应该发挥更大的作用。我们假设充盈压升高的患者更愿意冒险或牺牲时间来获得更好的健康。此外，强化住院治疗与充盈压力的改善将改善患者的偏好。HF受试者将完成几种工具，包括时间权衡和标准赌博工具，以评估患者偏好。通过体格检查、脑钠肽水平和详细的超声心动图研究估计充盈压。研究对象的填充压力指数将与他们的生活质量和偏好评分进行比较。血流动力学与偏好的这种相关性有可能提高QOL评估的临床效用，影响困难决策的方法，并确定改善QOL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.