Table 2.
Hypothetical Heart Failure Patient Vignette Used to Frame Interviews
| Characteristic | ||
|---|---|---|
| Demographics | 67‐year‐old, white male; married, 2 nonlocal children | |
| History | ● 3 hospitalizations within the past year for acute HF decompensation events ● History of ST elevation myocardial infarct 5 years ago followed by coronary artery bypass grafting ● On recent cardiac catheterization, has multivessel coronary artery disease with all grafts patent ● No ischemia on stress testing and no angina symptoms |
|
| BMI | 34.5 kg/m2 | |
| Ejection fraction | 18% | |
| Transplantation | Carefully reviewed by transplantation team and deemed ineligible for cardiac transplantation or other cardiac surgery due to age, kidney disease, and insulin‐dependent diabetes | |
| Dyspnea | 9/10 on exertion; 3/10 at rest | |
| Orthopnea | 4‐pillow orthopnea | |
| Edema | Reports worsening bilateral lower extremity edema over the last 2 weeks | |
| Pain | 5/10 over the past 2 weeks, in both legs and limiting walking | |
| Depression | Moderate over the past 2 weeks | |
| Physical exam | Vitals: SBP 88, HR 80 Neck: JVP elevated 10 cm Irregular rate, 3/6 systolic murmur consistent with mitral regurgitation Lungs with bilateral rales at both bases Abdomen normal Extremities: bilaterally edema, 2/4, pitting |
|
| NT‐ProBNP | 2100 pg/mL | |
| Devices | Implantable biventricular pacemaker—cardioverter‐defibrillator; ventricular resynchronization×3 years (not recent) | |
| Comorbidities | ● Atrial fibrillation ● Major depression ● Chronic kidney disease, stage 3, creatinine 2.5 mg/dL and has increased from 2.0 in the past 2 months ● Hypertension; recently with hypotension due to heart failure and has not tolerated higher doses of antihypertensive medications ● Type II diabetes mellitus |
|
| Current medications | ● Lisinopril 5 mg QD ● Furosemide 80 mg BID ● Carvedilol 3.125 mg BID ● Spironolactone 12.5 mg QD |
● Insulin lispro ● Humulin n ● Bupropion xl 300 mg QD ● Warfarin |
BID indicates twice daily; BMI, body mass index; HF, heart failure; HR, heart rate; JVP, jugular venous pressure; NT‐ProBNP, N‐terminal prohormone of brain natriuretic protein; QD, daily; SBP, systolic blood pressure.