Estimation of life expectancy serves an important role in clinical decisions about screening for disease and treatment in primary care practices. Increasingly, clinical guidelines recommend a course of action in context of the patient's life expectancy. While many tools have been developed to estimate life expectancy or the likelihood of surviving for a period of time, there are no well-established decision support tools that are broadly applicable to primary care.

For a life expectancy calculator to gain widespread use in primary care, it needs to have acceptable and validated predictive accuracy at decision-relevant times such as 6 months or 5 years, proven usefulness, and be readily available. In 2012, a systematic review by Yourman et al summarized existing life expectancy calculators that may be useful for older patients in primary care. However, none of the reviewed calculators met our criteria for widespread use. The purpose of this systematic review was to update the search on life expectancy calculators, with focus on calculators that may be valuable for use in the Veterans Health Administration population receiving primary care.

Contents

• PREFACE
• DEFINITIONS
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • RESULTS
  • DISCUSSION
• INTRODUCTION
  • KQ1. Between 2011 and 2016, have there been any additional reports of life expectancy calculators that may have sufficient predictive accuracy for use in adult primary care practice?
  • KQ2. Of the life expectancy calculators being reviewed, have any external validation studies been published between 2011 and 2016? If yes, what population was studied and what was the predictive accuracy therein?
  • KQ3. What is the clinical use of the mortality prediction models (aka life expectancy calculators), and was there improvement in patient survival times, health-related quality of life, provider-patient communication, patient satisfaction and participation in clinical decisions, or lower healthcare utilization and costs?
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE STRENGTH OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION 1. Between 2011 and 2016, have there been any additional reports of life expectancy calculators that may have sufficient predictive accuracy for use in adult primary care practice?
  • KEY QUESTION 2. Of the life expectancy calculators being reviewed, have any external validation studies been published between 2011 and 2016? If yes, what population was studied and what was the predictive accuracy therein?
  • KEY QUESTION 3. What is the clinical use of the mortality prediction models (aka life expectancy calculators), and was there improvement in patient survival times, health-related quality of life, provider-patient communication, patient satisfaction and participation in clinical decisions, or lower healthcare utilization and costs?
• SUMMARY AND DISCUSSION
  • KEY FINDINGS
  • LIMITATIONS
  • APPLICABILITY OF FINDINGS TO THE VA POPULATION
  • RESEARCH GAPS/FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A. SEARCH STRATEGY
• APPENDIX B. PEER REVIEW COMMENTS/AUTHOR RESPONSES
• APPENDIX C. EVIDENCE TABLES

Suggested citation:

Rector T, Taylor BC, Sultan S, Shaukat A, Adabag S, Nelson D, Capecchi T, MacDonald R, Greer, N, Wilt TJ. Life Expectancy Calculators, VA ESP Project #09-009; 2016.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Minneapolis VA Medical Center, Minneapolis, MN, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.