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

Abstract

Background: Clinical and ethical issues persist in determining candidacy for advanced heart failure (HF) therapies in elderly patients. Selection takes many factors into account, including "activation" (engagement and ability to self-manage).

Objective: To investigate effects of age, activation, and depression/anxiety on selection and 6-month survival of participants considered for therapy.

Methods: Consecutive people referred for advanced HF therapy completed the Patient Activation Measure and Hospital Anxiety and Depression Scale. We analyzed data from participants by age (≥65 vs. <65 years), stratified by approval for therapy.

Results: Among 168 referred, 109 were approved, with no difference in activation between age groups (88% highly activated). Similarly, activation was not associated with age among those not approved. Activation was related to anxiety in older, approved participants, but not to depression.

Conclusions: Concerns regarding reduced self-management in the elderly may not be valid. Age alone should not disqualify a candidate for advanced HF therapy.

Keywords: Aging; Cardiac transplantation; Patient activation; Selection criteria; Ventricular assist device.