Patient activation with respect to advanced heart failure therapy in patients over age 65 years

Area of Science:

• Cardiology
• Geriatrics
• Health Psychology

Background:

• Determining candidacy for advanced heart failure (HF) therapies in elderly patients presents clinical and ethical challenges.
• Patient 'activation,' defined as engagement and self-management capacity, is a key selection factor.

Purpose of the Study:

• To examine the influence of age, patient activation, and psychological factors (depression/anxiety) on selection for advanced HF therapy.
• To assess the impact of these factors on 6-month survival rates in patients considered for therapy.

Main Methods:

• Consecutive patients referred for advanced HF therapy completed validated measures of patient activation and anxiety/depression.
• Data were analyzed comparing participants aged ≥65 years versus <65 years, stratified by therapy approval.

Main Results:

• Of 168 referred patients, 109 were approved for therapy.
• Patient activation levels were high (88%) and did not differ significantly between age groups, both among approved and non-approved candidates.
• Activation correlated with anxiety in older, approved participants, but not with depression.

Conclusions:

• Concerns about reduced self-management capabilities in elderly patients considered for advanced HF therapy may be unfounded.
• Chronological age alone should not preclude patients from receiving advanced heart failure therapies.