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doi:10.1136/bmj.a286

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People with heart failure are overoptimistic about survival

JAMA2008;299:2533-42

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Chronic heart failure is a serious disease with a prognosis comparable to some advanced cancers⇑. Whereas patients with cancer are generally aware of the likely outcome, a cohort of patients with heart failure recently overestimated their survival by around 40% on average. Only a third agreed that heart failure would shorten their lives. Younger patients and those with the most severe heart failure were particularly overoptimistic, partly because severity of symptoms had no effect on their estimates. Patients with New York Heart Association (NYHA) class I disease guessed they would live for about 12 years, but so did those classified as NYHA class IV.

This small study (n=122) suggests that doctors aren’t very good at discussing the poor prognosis associated with heart failure, or that patients aren’t very good at believing them, say the authors. Perhaps it doesn’t matter, so long as treatments continue to improve and are based on symptoms not on a “guesstimate” of prognosis, accurate or otherwise, says an editorial (p 2566). Even the best prognostic tools, such as the one used in this study, have a relatively wide margin of error. If it is impossible to give people accurate information about the time they have left, it may not be fair to reduce the quality of life and dignity afforded by hope.

Pituitary dysfunction is common in elite boxers

Ann Intern Med2008;148:827-31

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When researchers tested the pituitary function of 61 apparently healthy Turkish boxers they found that nine had growth hormone deficiency and five had adrenocorticotrophic hormone deficiency. Overall, nearly one in five had some kind of pituitary dysfunction, a substantially higher prevalence than the 33 per 100 000 expected in the general population. Almost half the 17 retired boxers, who had been active in the sport for longest, had growth hormone deficiency.

All the participants were, or had been, elite amateur boxers on the …