Perceptions of heart failure
Editor – I read with interest Banerjee's paper about patients' understanding and perceptions of the diagnosis of heart failure (Clin Med Aug 2010 pp 339–43). Much is often made of the poor prognosis of heart failure when compared with various malignancies. However, it is only at the level of prognosis that people seem to draw comparisons. Why?
Patients understand that malignancy is serious and as such patients are aware that treatment is necessary if life is to be prolonged. The same cannot necessarily be said of heart failure patients. In an audit performed in a GPS practice of patients with heart failure managed in primary care, I found that only a third of patients were on maximum tolerated doses of ace inhibitor and betablocker, ie being treated as aggressively as possible. It is hard to imagine only a third of cancer sufferers getting full doses of chemotherapeutic agents. Furthermore, when the rationale for repeated appointments to increase the doses of these medications was explained to patients, every patient attended for further uptitration of their medications.
If we do not tell patients negative prognostic information, then how can we expect them to engage with multiple appointments and blood tests, and comply with new medication regimens which may not make them feel any better in the short term but will offer them advantages in mortality and morbidity?
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- Royal College of Physicians
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