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
Patients' misperception of their prognosis has the potential to affect their adherence to physician recommendations for treatment. However, the overall rate of smoking (12%) did not vary significantly according to how accurately the patient perceived his or her prognosis, nor did the overall rate at which the patients had consented to implantable cardiac defibrillator placement (25%). The prescribed medication regimens likewise seemed similar for patients in the several categories, but it would be of interest to know if patients' medication adherence to the prescribed regimens differed if they underestimated their need for medical management (ie, they overestimated their life expectancy) or if they underestimated how much they might potentially gain from medication adherence (ie, they markedly underestimated their life expectancy).
Denial of prognosis can be a coping mechanism for some patients, and one which patients may employ selectively. It is possible that many patients with congestive heart failure rely on denial when they are asked to focus directly on issues of their own mortality, yet recognize the seriousness of their condition when they consider how to make day-to-day medical decisions about its management.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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