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Heart-to-heart talks help heart failure

Poor communication between people with failing hearts and their doctors and nurses complicates -- sometimes even counteracts -- heart failure treatment.

Advances in our understanding of heart failure and the development of new drugs and treatments are helping people with this condition live longer and better than they did 20 years ago. That said, heart failure kills a quarter of a million Americans a year. It's also the No. 1 reason why older people end up in the hospital.

Despite its ominous name, heart failure doesn't mean a heart teetering on the brink of stopping forever. Instead, it describes a heart that's failing to pump enough blood to meet the body's needs. In spite of this, many people continue to function somewhat normally. But there are people who wait too long to get advice or treatment for escalating symptoms. In fact, this is one of the top reasons people with heart failure end up in the hospital.

The more serious your heart failure, the more important it is to take stock of what you want for your immediate situation and your future. Clarifying these preferences can help you and your doctors map a strategy that will give you what you need and what you want.

"Some people will do everything in their power to hang on another six months to see a grandchild born or finish an important project," says cardiologist Lynne Warner Stevenson, director of the heart failure program at Harvard-affiliated Brigham and Women's Hospital. "Others want to focus on feeling better today." Thinking through questions like these can help you talk with your doctor or nurse about the direction of your treatment:

  • How do I feel?
  • What bothers me most? (This may not be heart failure but some other problem.)
  • How do I want to feel?
  • If I could fix just one thing right now, what would it be?
  • What is the one thing I would like to do or achieve but feel I can't?
  • Am I having trouble with my medications?

Open communication that includes hopes, fears, and needs isn't easy. Doctors and nurses don't always have the time, or take the time, to pursue or continue such conversations. And many people don't want to "bother" their care providers with personal issues, or feel that discussions like this aren't appropriate. Quite the contrary -- they're not only appropriate, they're essential.

The more you and your doctor personalize the way you manage your heart failure, the better the chances that you'll control it rather than the other way around.

January 2004 Update

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