Doctors uncertain about approaches to care for heart failure patients, SLU study finds

Difficulty predicting how close a patient is to death, lack of knowledge regarding treatment options undermine care

ST. LOUIS – Less than one fourth of physicians specializing in geriatrics, internal or family medicine or cardiology believe they can accurately predict the whether patients with heart failure are at risk of dying, new Saint Louis University research found.

The ability to determine whether patients are within six months of death is crucial to clinical care, impacting key patient-care decisions such as therapeutic approaches and referral for palliative care, which is focused on symptom relief rather than cure.

“Our findings are important not only in light of the increasing prevalence of heart failure in the United States but because the data show that there are considerable gaps in knowledge regarding end-stage heart failure that ultimately affect a patient’s experience with their illness,” says Paul Hauptman, M.D., professor of internal medicine at Saint Louis University School of Medicine and the study’s lead author.

“Palliative measures can be adopted to ease the pain of patients with terminal heart failure, but these measures are not always utilized because of uncertainty about the patient’s prognosis. Unlike cancer, for example, predicting death is not always clear with end-stage heart failure.”

Across the board, physicians reported that they were unlikely to refer a patient with end-stage heart failure for hospice care. Their reluctance was due in part to uncertainty about timing and patient acceptance of the recommendation.

“This study will provide valuable insight into physicians’ beliefs and biases in regards to end-stage heart failure,” Hauptman said. “This area has not been previously explored, but is essential if we are to design interventions to help physicians select appropriate care options for their patients.”

Among the three specialties studied, geriatricians were the most confident in predicting six-month mortality. Physicians who work in group practices, have large clinical volume, and those who had formal training in palliative care, express a willingness to objectively measure functional status and refer patients to hospice care were more confident in predicting six-month mortality.

End-stage heart failure or terminal heart failure is characterized by fatigue, shortness of breath, progressive muscle wasting and inability to exercise despite optimal medical and surgical therapy.