ABSTRACT
Heart failure is affecting more people, and affecting them for longer. Medical technology and therapeutics grow apace, and while ‘cures’ are few and far between, there are an expanding number of treatment options available. While mortality rates from heart failure have fallen2,3 morbidity rates, due to the growing elderly population, may continue to rise.2 Thus, there are more and more conversations to be had between doctors and patients, discussing the nature and course of heart failure, prognosis, treatment options, and patient preferences for end-of-life care. As with other medical developments, the ethics and communication skills necessary to permit partnerships with patients have lagged behind the demographics and technology. Very few patients with heart disease have been given the opportunity to discuss end-of-life issues despite the fact that many have recognised death to be imminent.4,5 There is also evidence that people with heart failure have less understanding of their illness than in other chronic diseases,6 perhaps because the term ‘heart failure’ may not be familiar to patients,5 and consideration of imminent death is largely confined to exacerbations.7 Many patients with heart failure are ready for, and would welcome, information regarding prognosis.8 This would suggest that there is an unmet need in this area of care and also that there is room for improvement in how we communicate with patients with heart failure.
