Imperial College London
Alternate

ProfessorDarrelFrancis

Faculty of Medicine, National Heart & Lung Institute

Professor of Cardiology
 
 
 
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Contact

 

+44 (0)20 7594 3381d.francis Website

 
 
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Assistant

 

Miss Juliet Holmes +44 (0)20 7594 5735

 
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Location

 

Block B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Zaman:2017:10.1002/ejhf.838,
author = {Zaman, S and Zaman, S and Scholtes, T and Shun-Shin, MJ and Plymen, CM and Francis, DP and Cole, GD},
doi = {10.1002/ejhf.838},
journal = {European Journal of Heart Failure},
pages = {1401--1409},
title = {The mortality risk of deferring optimal medical therapy in heart failure: a systematic comparison against norms for surgical consent and patient information leaflets},
url = {http://dx.doi.org/10.1002/ejhf.838},
volume = {19},
year = {2017}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Aims: The  prescription  of  optimal  medical  therapy  for  heart  failure  is  often  delayed  despite  compelling  evidence  of  the reductions in mortality it may facilitate. We calculated the absolute risk resulting from delayed prescription of therapy. For comparison, we established the threshold applied by clinicians when discussing the risk for death associated with an intervention, and the threshold used in of ficial patient information leaflets.Methods and results:We undertook a meta-analysis of randomized controlled trials to calculate the  excess  mortality  caused  by  deferral of medical therapy for 1 year. Risk ratios for angiotensin-converting enzyme inhibitors, beta-blockers and aldosterone antagonists  were  0.80,  0.73  and  0.77,  respectively.  In  patients  who  might  achieve  a 1-year  survival  rate  of  90%  if treated, a 1-year deferral of treatment reduced survival to 78% (i.e. an annual absolute increase in mortality of 12 in 100 patients). This corresponds to an additional absolute mortality risk per month of 1%. A survey of clinicians carried out to establish the risk threshold at which they would obtain written consent showed the majority (85%) sought written consent for interventions associated with a 12-fold lower mortality risk: one in 100 patients. A systematic review of UK patient information leaflets to establish the magnitude of risk considered sufficient to be stated explicitly showed that leaflets begin to mention death at a ∼18 000-fold lower mortality risk of just 0.0007 in 100 patients.Conclusions:Deferring heart failure treatment for 1 year carries far greater risk than the level at which most doctors seek written consent, and 18000 times more risk than the level at which patient information leaflets begin to mention death.
AU  - Zaman,S
AU  - Zaman,S
AU  - Scholtes,T
AU  - Shun-Shin,MJ
AU  - Plymen,CM
AU  - Francis,DP
AU  - Cole,GD
DO  - 10.1002/ejhf.838
EP  - 1409
PY  - 2017///
SN  - 1879-0844
SP  - 1401
TI  - The mortality risk of deferring optimal medical therapy in heart failure: a systematic comparison against norms for surgical consent and patient information leaflets
T2  - European Journal of Heart Failure
UR  - http://dx.doi.org/10.1002/ejhf.838
UR  - http://hdl.handle.net/10044/1/45654
VL  - 19
ER  -
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