title: Heart failure patients' future expectations and their association with disease severity, quality of life, depressive symptoms and clinical outcomes.
abstract: BACKGROUND
  Although treatment of heart failure (HF) patients has improved, prognosis still remains poor. Current HF Guidelines recommend communication about prognosis with all patients. Little is known about HF patients' awareness of their shortened life expectancy.
  
  
  OBJECTIVE
  To explore HF patients' future expectations and to examine whether these expectations are associated with disease severity, quality of life, depressive symptoms and clinical outcomes.
  
  
  METHODS
  Patients randomised to the intervention groups of the COACH study, who were at the end of HF hospitalisation, were asked about their future expectations. Patients were divided into three groups: patients expecting improvement/stabilisation, patients expecting deterioration and those not knowing what to expect. Depressive symptoms were measured by CES-D and quality of life with the Ladder of Life and RAND-36.
  
  
  RESULTS
  Six hundred and seventy eight patients (age 70 ± 12; 41% female patients; LVEF 33% ± 15) participated in the study. Most patients (56%, N = 380) expected improvement or stabilisation, 8% (N = 55) expected deterioration and 21% (N = 144) did not know what to expect for the future. Patients who expected to deteriorate were significantly older, experienced a lower quality of life and more depressive symptoms compared with patients in the other two groups. They also had a higher mortality rate, both after 18 and 36 months, and had more HF admissions. No association with severity of the disease (NYHA-class, LVEF, BNP levels) was found.
  
  
  CONCLUSIONS
  Many hospitalised HF patients are not aware of their poor prognosis. Depressive symptoms, poor quality of life, increased mortality and rehospitalisation were related to expected deterioration. Improvement of communication about prognosis with HF patients is needed in the future.
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.|Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: M H L
authors.identifier: http://orcid.org/0000-0001-7853-7340
authors.initials: MH
authors.lastname: van der Wal
authors.affiliation: Department of Medical and Health Sciences, Division of Nursing and Department of Cardiology, Linköping University, Linköping, Sweden.|UCI Program in Nursing Science, University of California Irvine, Irvine, CA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Strömberg
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: D J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.|Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Vic., Australia.
authors.forename: T
authors.initials: T
authors.lastname: Jaarsma
mesh_terms: D000368:Aged; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D006299:Health Services for the Aged; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D008297:Male; D011379:Prognosis; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome