Understanding of Prognosis and Estimation of Mortality in Ambulatory Patients With Heart Failure

Importance: Accurate patient understanding of prognosis is essential for informed decision-making to pursue therapies for advanced heart failure (HF). Objectives: To evaluate (1) patient characteristics associated with overestimating survival with HF and (2) whether overestimation is associated with mortality. Design, Setting, and Participants: This prospective cohort study was an exploratory secondary analysis of data from the multicenter US Registry Evaluation of Vital Information for Ventricular Assist Devices (VADs) in Ambulatory Life (REVIVAL) study. Participants were high-risk ambulatory patients with HF with reduced ejection fraction enrolled from July 2015 to June 2016. Data were analyzed from December 1, 2024, to December 16, 2025. Exposures: Patient characteristics (eg, age) and estimation index (EI), defined as the ratio of patient-estimated life expectancy to Seattle Heart Failure Model (SHFM)-estimated mean survival (EI