Haider Warraich
speaker
683 appearances
3 recordings
1 series
first heard Oct 2020
last heard Dec 2021
Haider Warraich’s voice in public audio — every appearance, attributed to the second.
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About half of our patients with heart failure, and these are patients who are relatively older, who have more comorbidities, have preserved ejection fractures.
So they have clinical heart failure, but their heart squeeze is not the issue.
It's just that their heart becomes stiff.
And these are patients from home, none of the traditional things that I've already mentioned, like ICDs, like medications, like LVADs, have really any proven rule to change their quality of life or their survivability.
And so you would think that, oh, this is a group of patients that have a highly symptomatic condition, that have multiple medical comorbidities, and often in older individuals.
So this would be a perfect population that would benefit from a palliative care intervention.
And yet we've known that actually these patients are even less likely to
to get palliative care referrals than patients with reduced ejection fraction.
And in fact, when I mentioned earlier that physicians are very bad at assessing prognosis, they're especially bad in assessing prognosis in patients with preserved ejection fraction.
Because one of the tips that I give in that paper that was briefly mentioned is that a lot of times when we look at these heart failure patients, we look at their ejection fraction and we think, oh, this patient is a low ejection fraction.
Oh, that patient is going to do much worse than a patient with a normal ejection fraction.
If you look at the studies, what it shows is that ejection fraction is not prognostic at all.
In fact, in older individuals with heart failure, the survival of a patient with HEF-FEF is essentially the same as the survival of a patient with HEF-REF.
So ejection fraction, even though it's such a central way that we get a sense for what's going on with this patient with heart failure, it actually doesn't inform us when it comes to getting a sense for how sick they might be or how much time they might have left.
So I use, you know, I think I use something very basic.
I will ask myself, would I be surprised if this person were to dive in the next one or two years?
I use kind of both one or two years.
I give myself that wiggle room and certainly
And there's some recent data to suggest that this question is not as useful in patients with heart failure as it is with, say, cancer, but it is better than what we
at that I think are really, really important when it comes to getting a sense for how if this patient is truly approaching the end of life, so to speak, is recurrent hospitalizations are a big one.
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