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November 12, 2008

Patient-Predicted Life Expectancy Among Ambulatory Patients With Heart Failure

JAMA. 2008;300(18):2116-2117. doi:10.1001/jama.2008.551

To the Editor: In the study by Dr Allen and colleagues,1 a patient's prediction of his or her life expectancy seemed to bear a relatively close relationship to that based on the actuarial survival for all individuals of the same age and sex, with only a minimal influence from the fact that they had congestive heart failure. The majority of the patients in the study (76/122, 63%) claimed never to have spoken with their physicians about their prognosis once they developed heart failure. Patient denial of whatever information they did receive may also have played an important role in how some patients coped with their illness,2 particularly for many of those who most heavily overestimated their own survival. Patient fatalism and depression may conversely have contributed to the cases of patient underestimates of their survival, although the psychosocial data in Table 1 suggest that depression was a minor issue in this patient population compared with that seen in another study of patients with congestive heart failure at the same institution.3