Background: Accurate understanding of life-expectancy is critical to shared decision making for heart failure (HF) patients. HF patients largely over-estimate their life expectancy compared to model predicted estimates in cross-sectional studies. This study evaluates if patient understanding of prognosis associated with HF changes over time.Methods: We analyzed 298 ambulatory patients with high-risk HF from the prospective, multicenter, REVIVAL registry. Patients were asked to predict their survival in the absence of advanced HF therapies at baseline enrollment and follow-up visits at 6-month intervals. Changes in patient predicted survival from baseline to follow-up were assessed using a repeated measures regression analysis, adjusted for baseline predicted survival, time and patient characteristics.Results: Included patients had a median (IQI) age of 62 (65-78) years, 224 (75%) were male and had a median (IQI) number of 4 (2-5) assessments of patient predicted survival. At baseline enrollment, 38% patients overestimated their survival by 30% or more than the Seattle Heart Failure model. With time, on an average, patient predicted survival did not change (Figure 1a). Black race and higher baseline INTERMACS score (suggesting less severe disease) correlated with an increase in patient predicted survival over time. Whereas a higher baseline patient predicted survival correlated with a decrease in predicted survival over time (Figure 1b).Conclusions: In a cohort of high-risk HF patients, patient predicted survival was greater than model predicated and did not change with time. These findings suggest continued poor understanding of disease prognosis that could impact decision-making for therapies and highlight the need to develop strategies to improve prognosis communication with HF patients.