title: Choices: a study of preferences for end-of-life treatments in patients with advanced heart failure.
abstract: BACKGROUND
  The purpose of this study is to describe the treatment preferences of patients with heart failure among three distinct treatment options--optimal medical management, oral inotropes or left ventricular device (LVAD) support--to determine if there were differences in preferences between patients with mild heart failure (New York Heart Association [NYHA] Class II) and severe heart failure (NYHA Class IV), and also to determine whether quality of life, perceived severity of symptoms and overall health influenced treatment preferences.
  
  
  METHODS
  We enrolled 91 patients who completed the Minnesota Living with Heart Failure Questionnaire (MLHFQ); visual analog scales for depicting their perceived severity of overall health, dyspnea and fatigue; and a treatment trade-off tool.
  
  
  RESULTS
  The most preferred treatment options were oral inotropes, LVAD and standard medical management. There were no differences in treatment preferences between NYHA II and NYHA IV patients. Patient preferences correlated poorly with MLHFQ, symptom and overall health scores. Although not statistically significant, there was a trend toward patients with worse quality of life and symptom scores preferring more aggressive treatment.
  
  
  CONCLUSIONS
  The results of our study identified two distinct groups of patients: one group preferring treatments that prolonged survival time and another group that favored strategies that improved quality of life but reduced survival time. Treatment preferences were independent of functional or symptom status, suggesting that preferences may be decided early in the course of illness.
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: MacIver
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
authors.forename: Diego H
authors.initials: DH
authors.lastname: Delgado
authors.forename: Nimesh
authors.initials: N
authors.lastname: Desai
authors.forename: Joan
authors.initials: J
authors.lastname: Ivanov
authors.forename: Susan
authors.initials: S
authors.lastname: Abbey
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Ross