{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T17:17:22Z","timestamp":1772558242341,"version":"3.50.1"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Accurate patient understanding of prognosis is essential for informed decision-making to pursue therapies for advanced heart failure (HF).<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To evaluate (1) patient characteristics associated with overestimating survival with HF and (2) whether overestimation is associated with mortality.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This prospective cohort study was an exploratory secondary analysis of data from the multicenter US Registry Evaluation of Vital Information for Ventricular Assist Devices (VADs) in Ambulatory Life (REVIVAL) study. Participants were high-risk ambulatory patients with HF with reduced ejection fraction enrolled from July 2015 to June 2016. Data were analyzed from December 1, 2024, to December 16, 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Patient characteristics (eg, age) and estimation index (EI), defined as the ratio of patient-estimated life expectancy to Seattle Heart Failure Model (SHFM)\u2013estimated mean survival (EI &amp;lt;0.5, discordantly pessimistic; 0.5 to &amp;lt;1.5, concordant; and \u22651.5, discordantly optimistic).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes were EI and 2-year all-cause mortality. Factors associated with EI were estimated using ordered logistic regression. Association between EI and mortality was assessed using a cause-specific Cox proportional hazards regression model with VAD and heart transplant as censoring events.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 296 high-risk, ambulatory patients with chronic HF were included; 223 (75.3%) were male, and mean (SD) age was 60.1 (11.5) years. The median SHFM-estimated survival was 8.2 years (IQR, 5.1-12.1 years), and median patient-estimated life expectancy was 7.0 years (IQR, 5.0-10.0 years). In all, 98 patients (33.1%) were discordantly optimistic. Increasing EI was associated with increased mortality in the univariable model, which was attenuated with multivariable adjustment (adjusted hazard ratio [AHR] for concordant optimism, 1.21 [95% CI, 0.49-2.99] and for discordant optimism, 2.23 [95% CI, 0.94-5.33] vs discordant pessimism). Compared with discordantly pessimistic or concordantly optimistic estimates (EI &amp;lt;1.5), discordant optimism was associated with increased hazard of 2-year mortality (AHR, 1.98; 95% CI, 1.04-3.77) but a similar hazard for a VAD or heart transplant compared with discordant pessimism (HR, 1.24; 95% CI, 0.64-2.41) in a post hoc analysis.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this cohort study, discordant optimism regarding life expectancy compared with model estimates was common and associated with mortality that was not due to a lower probability of receiving a heart transplant or VAD. The findings suggest clinicians should objectively evaluate HF risk when considering advanced therapies, rather than relying primarily on patient-reported symptoms.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.0328","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T16:00:23Z","timestamp":1772553623000},"page":"e260328","source":"Crossref","is-referenced-by-count":0,"title":["Understanding of Prognosis and Estimation of Mortality in Ambulatory Patients With Heart Failure"],"prefix":"10.1001","volume":"9","author":[{"given":"Thomas M.","family":"Cascino","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Michigan, Ann Arbor"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"Herron","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Michigan, Ann Arbor"},{"name":"University of Michigan Medical School, University of Michigan, Ann Arbor"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blair","family":"Richards","sequence":"additional","affiliation":[{"name":"Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"II","given":"James W.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University of Michigan, Ann Arbor"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wayne C.","family":"Levy","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington, Seattle"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey D.","family":"Barnes","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Michigan, Ann Arbor"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colleen K.","family":"McIlvennan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Colorado, Aurora"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy C.","family":"Taddei-Peters","sequence":"additional","affiliation":[{"name":"National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal","family":"Jeffries","sequence":"additional","affiliation":[{"name":"National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas L.","family":"Mann","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Washington University, St Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josef","family":"Stehlik","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Utah, Salt Lake City"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Garrick C.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith D.","family":"Aaronson","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Michigan, Ann Arbor"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Supriya","family":"Shore","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Michigan, Ann Arbor"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"issue":"8","key":"zoi260026r1","doi-asserted-by":"publisher","first-page":"e93","DOI":"10.1161\/CIR.0000000000001123","article-title":"Heart disease and stroke statistics\u20132023 update: a report from the American Heart Association.","volume":"147","author":"Tsao","year":"2023","journal-title":"Circulation"},{"issue":"18","key":"zoi260026r2","doi-asserted-by":"publisher","first-page":"e895","DOI":"10.1161\/CIR.0000000000001063","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines.","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"issue":"36","key":"zoi260026r3","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"issue":"12","key":"zoi260026r4","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1001\/jama.2022.16197","article-title":"Five-year outcomes in patients with fully magnetically levitated vs axial-flow left ventricular assist devices in the MOMENTUM 3 randomized trial.","volume":"328","author":"Mehra","year":"2022","journal-title":"JAMA"},{"issue":"11","key":"zoi260026r5","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1016\/j.jacc.2022.01.017","article-title":"Trends and outcomes of left ventricular assist device therapy: JACC focus seminar.","volume":"79","author":"Varshney","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"10","key":"zoi260026r6","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1016\/j.healun.2019.08.004","article-title":"The international thoracic organ transplant registry of the International Society for Heart and Lung Transplantation: thirty-sixth adult heart transplantation report\u20142019; focus theme: donor and recipient size match.","volume":"38","author":"Khush","year":"2019","journal-title":"J Heart Lung Transplant"},{"issue":"8","key":"zoi260026r7","first-page":"1120","article-title":"Adult heart transplant: indications and outcomes.","volume":"6","author":"Alraies","year":"2014","journal-title":"J Thorac Dis"},{"issue":"1","key":"zoi260026r8","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.athoracsur.2023.11.004","article-title":"The Society of Thoracic Surgeons Intermacs 2023 annual report: focus on magnetically levitated devices.","volume":"117","author":"Jorde","year":"2024","journal-title":"Ann Thorac Surg"},{"issue":"5","key":"zoi260026r9","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1161\/CIRCULATIONAHA.107.691972","article-title":"Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era: implications for patient selection.","volume":"116","author":"Lietz","year":"2007","journal-title":"Circulation"},{"issue":"12","key":"zoi260026r10","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.1016\/j.jacc.2020.01.034","article-title":"Evaluation for heart transplantation and LVAD implantation: JACC council perspectives.","volume":"75","author":"Guglin","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"15","key":"zoi260026r11","doi-asserted-by":"publisher","first-page":"1928","DOI":"10.1161\/CIR.0b013e31824f2173","article-title":"Decision making in advanced heart failure: a scientific statement from the American Heart Association.","volume":"125","author":"Allen","year":"2012","journal-title":"Circulation"},{"issue":"21","key":"zoi260026r12","doi-asserted-by":"publisher","first-page":"2533","DOI":"10.1001\/jama.299.21.2533","article-title":"Discordance between patient-predicted and model-predicted life expectancy among ambulatory patients with heart failure.","volume":"299","author":"Allen","year":"2008","journal-title":"JAMA"},{"issue":"6","key":"zoi260026r13","doi-asserted-by":"publisher","first-page":"3452","DOI":"10.1002\/ehf2.12941","article-title":"Dying to know: prognosis communication in heart failure.","volume":"7","author":"Cavanagh","year":"2020","journal-title":"ESC Heart Fail"},{"issue":"2","key":"zoi260026r14","first-page":"e101","article-title":"Discussing prognosis with patients and their families near the end of life: impact on satisfaction with end-of-life care.","volume":"3","author":"Heyland","year":"2009","journal-title":"Open Med"},{"issue":"6","key":"zoi260026r15","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.123.010662","article-title":"Prognosis communication in heart failure: experiences and preferences of end-stage heart failure patients and care partners.","volume":"17","author":"Shore","year":"2024","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"1","key":"zoi260026r16","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.healun.2019.09.008","article-title":"Registry Evaluation of Vital Information for VADs in Ambulatory Life (REVIVAL): rationale, design, baseline characteristics, and inclusion criteria performance.","volume":"39","author":"Aaronson","year":"2020","journal-title":"J Heart Lung Transplant"},{"issue":"10","key":"zoi260026r17","doi-asserted-by":"publisher","first-page":"1734","DOI":"10.1016\/j.jchf.2024.05.008","article-title":"Optimizing triage of ambulatory patients with advanced heart failure: 2-year outcomes from REVIVAL.","volume":"12","author":"Aaronson","year":"2024","journal-title":"JACC Heart Fail"},{"issue":"11","key":"zoi260026r18","doi-asserted-by":"publisher","first-page":"1424","DOI":"10.1161\/CIRCULATIONAHA.105.584102","article-title":"The Seattle Heart Failure Model: prediction of survival in heart failure.","volume":"113","author":"Levy","year":"2006","journal-title":"Circulation"},{"issue":"1","key":"zoi260026r19","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.healun.2019.11.006","article-title":"Quality of life and treatment preference for ventricular assist device therapy in ambulatory advanced heart failure: a report from the REVIVAL study.","volume":"39","author":"Stehlik","year":"2020","journal-title":"J Heart Lung Transplant"},{"issue":"20","key":"zoi260026r20","doi-asserted-by":"publisher","first-page":"2268","DOI":"10.1001\/archinte.168.20.2268","article-title":"Patient awareness of chronic kidney disease: trends and predictors.","volume":"168","author":"Plantinga","year":"2008","journal-title":"Arch Intern Med"},{"issue":"7","key":"zoi260026r21","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.23080","article-title":"Racial and sex inequities in the use of and outcomes after left ventricular assist device implantation among Medicare beneficiaries.","volume":"5","author":"Cascino","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zoi260026r22","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.122.009745","article-title":"Racial inequities in access to ventricular assist device and transplant persist after consideration for preferences for care: a report from the REVIVAL study.","volume":"16","author":"Cascino","year":"2023","journal-title":"Circ Heart Fail"},{"issue":"4","key":"zoi260026r23","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1016\/j.cardfail.2022.09.016","article-title":"Readability and non-English language resources of heart transplant center websites in the United States.","volume":"29","author":"Stewart","year":"2023","journal-title":"J Card Fail"},{"issue":"5","key":"zoi260026r24","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.119.006858","article-title":"Comorbid conditions and health-related quality of life in ambulatory heart failure patients: REVIVAL (Registry Evaluation of Vital Information for VADs in Ambulatory Life REVIVAL).","volume":"13","author":"Cascino","year":"2020","journal-title":"Circ Heart Fail"},{"issue":"6","key":"zoi260026r25","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1001\/jamacardio.2018.0589","article-title":"Social Worker-Aided Palliative Care Intervention in High-risk Patients With Heart Failure (SWAP-HF): a pilot randomized clinical trial.","volume":"3","author":"O\u2019Donnell","year":"2018","journal-title":"JAMA Cardiol"},{"issue":"6","key":"zoi260026r26","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1016\/j.cardfail.2021.03.005","article-title":"Non-concordance between patient and clinician estimates of prognosis in advanced heart failure.","volume":"27","author":"Gelfman","year":"2021","journal-title":"J Card Fail"},{"issue":"9","key":"zoi260026r27","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1016\/j.jchf.2017.04.009","article-title":"Discordant perceptions of prognosis and treatment options between physicians and patients with advanced heart failure.","volume":"5","author":"Ambardekar","year":"2017","journal-title":"JACC Heart Fail"},{"issue":"2","key":"zoi260026r28","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.cardfail.2009.09.003","article-title":"Patient expectations from implantable defibrillators to prevent death in heart failure.","volume":"16","author":"Stewart","year":"2010","journal-title":"J Card Fail"},{"issue":"3","key":"zoi260026r29","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.cardfail.2020.10.009","article-title":"Prognostic understanding and preference for the communication process with physicians in hospitalized heart failure patients.","volume":"27","author":"Kitakata","year":"2021","journal-title":"J Card Fail"},{"issue":"9","key":"zoi260026r30","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.12200","article-title":"Association of optimism with cardiovascular events and all-cause mortality: a systematic review and meta-analysis.","volume":"2","author":"Rozanski","year":"2019","journal-title":"JAMA Netw Open"},{"key":"zoi260026r31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2021.106899","article-title":"Optimism and risk of mortality among African-Americans: the Jackson Heart Study.","volume":"154","author":"Lee","year":"2022","journal-title":"Prev Med"},{"issue":"6","key":"zoi260026r32","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1037\/0022-3514.67.6.1063","article-title":"Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test.","volume":"67","author":"Scheier","year":"1994","journal-title":"J Pers Soc Psychol"},{"issue":"21","key":"zoi260026r33","doi-asserted-by":"publisher","first-page":"1709","DOI":"10.1001\/jama.279.21.1709","article-title":"Relationship between cancer patients\u2019 predictions of prognosis and their treatment preferences.","volume":"279","author":"Weeks","year":"1998","journal-title":"JAMA"},{"issue":"20","key":"zoi260026r34","doi-asserted-by":"publisher","first-page":"2379","DOI":"10.1016\/j.jacc.2020.09.542","article-title":"Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care: JACC state-of-the-art review.","volume":"76","author":"Spertus","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"zoi260026r35","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.cardfail.2023.09.008","article-title":"Equitable access to advanced heart failure therapies in the United States: a call to action.","volume":"30","author":"Cascino","year":"2024","journal-title":"J Card Fail"},{"issue":"11","key":"zoi260026r36","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1016\/j.healun.2011.05.012","article-title":"Selecting patients for heart transplantation: comparison of the Heart Failure Survival Score (HFSS) and the Seattle Heart Failure Model (SHFM).","volume":"30","author":"Goda","year":"2011","journal-title":"J Heart Lung Transplant"},{"issue":"4","key":"zoi260026r37","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1001\/jamacardio.2016.5036","article-title":"Use of risk models to predict death in the next year among individual ambulatory patients with heart failure.","volume":"2","author":"Allen","year":"2017","journal-title":"JAMA Cardiol"},{"issue":"7","key":"zoi260026r38","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1177\/0269216315626048","article-title":"Accuracy of physician prognosis in heart failure and lung cancer: comparison between physician estimates and model predicted survival.","volume":"30","author":"Warraich","year":"2016","journal-title":"Palliat Med"},{"issue":"4","key":"zoi260026r39","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1001\/jamainternmed.2017.8713","article-title":"Effectiveness of an intervention supporting shared decision making for destination therapy left ventricular assist device: the DECIDE-LVAD randomized clinical trial.","volume":"178","author":"Allen","year":"2018","journal-title":"JAMA Intern Med"},{"issue":"4","key":"zoi260026r40","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/j.cardfail.2016.12.008","article-title":"Patient perspectives on communication of individualized survival estimates in heart failure.","volume":"23","author":"Narayan","year":"2017","journal-title":"J Card Fail"},{"issue":"12","key":"zoi260026r41","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1007\/s12032-022-01776-y","article-title":"Patient-clinician communication and patient-centered outcomes among patients with suspected stage I non-small cell lung cancer: a prospective cohort study.","volume":"39","author":"Nugent","year":"2022","journal-title":"Med Oncol"},{"issue":"1","key":"zoi260026r42","first-page":"92","article-title":"Effect of a patient-centered communication intervention on oncologist-patient communication, quality of life, and health care utilization in advanced cancer: the VOICE randomized clinical trial.","volume":"3","author":"Epstein","year":"2017","journal-title":"JAMA Oncol"},{"issue":"7","key":"zoi260026r43","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1177\/0272989X211014163","article-title":"Systematic development of patient decision aids: an update from the IPDAS collaboration.","volume":"41","author":"Witteman","year":"2021","journal-title":"Med Decis Making"},{"issue":"2","key":"zoi260026r45","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1093\/eurjhf\/hfs162","article-title":"Validation of Seattle Heart Failure Model for mortality risk prediction in patients treated with cardiac resynchronization therapy.","volume":"15","author":"Regoli","year":"2013","journal-title":"Eur J Heart Fail"},{"key":"zoi260026r44","doi-asserted-by":"crossref","unstructured":"Shore? S, Li? H, Zhang? M, . Trajectory of cognitive function after incident heart failure.? medRxiv. Preprint posted online February 12, 2024. doi:10.1101\/2024.02.09.24302608?","DOI":"10.1101\/2024.02.09.24302608"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2845771\/cascino_2026_oi_260026_1772471947.26054.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T16:00:34Z","timestamp":1772553634000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2845771"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":45,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.0328","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]}}}