When Your Heart Is Weak, The Talk You Need To Have

For older patients with advanced  heart failure, heart devices are not always the best answer.

Instead, patients and their doctors need to engage in "shared decision-making" about treatment options and whether pacemakers, pumps, new valves, defibrillators or other invasive procedures may leave patients feeling worse off than they were before, says a new scientific statement published Monday by the American Heart Association and endorsed by other medical groups.

Too often, patients don't realize what they're getting into, and doctors automatically assume that patients want everything possible done to keep them alive, no matter the risk.

The result can be patients unprepared for the outcome or even left feeling that "the treatment was worse than the disease," cardiologist Larry Allen of the University of Colorado Anschutz Medical Center, who helped draft the new advice, told USA Today.

The heart association urges doctors and patients to tackle the difficult decisions about treatment early on and realize that "doing everything" is not always the right thing. For many patients, the discussion with their doctors should focus on "relief of symptoms, quality of life and living at home."

Heart failure, which strikes older adults more often, occurs when the heart becomes too weak to pump enough blood to meet the body's needs, causing shortness of breath, ankle swelling, and fatigue. Many diseases can weaken the heart, including blocked blood vessels, high blood pressure, and other conditions.

Patient advocate Jessie Gruman, a three-time cancer survivor, was asked by the association to review the advice from a patient's perspective. To her, the association's guidelines help patients think through what they want done should a person's heart condition suddenly worsen.

The worst thing, she told USA Today, is to have no plan or clear goals when an emergency occurs, leaving it up to caregivers who may never have done this before.

Among the heart association's recommendations:

*Shared decision-making that takes into account a patient's values, goals and preferences.

*Setting aside one day each year for heart failure patients and their doctors to discuss treatment goals for the patient's current health, as well as for possible emergencies, such as cardiac arrest.

*A "milestone" review discussion after any big health change like hospitalization, a defibrillator shock, worsening kidney problems or dementia.

*Explaining to patients potential problems resulting from devices, including side effects, loss of independence, quality of life, and obligations for families and caregivers.

*Planning for palliative care, should heart problems worsen, including recommending hospice services with the goal of keeping patient comfortable and at home and providing support for the family.

In other health news:

Estrogen after menopause lowers breast cancer risk. Women who take estrogen after menopause appear to have a lower risk of breast cancer even years after they quit taking the hormone, according to a new analysis of a landmark study. The results are reassuring news for women who have had hysterectomies and use the pills to relieve hot flashes and other symptoms of menopause.

Death of elderly man raises Pradaxa concerns. Researchers say that the death of an elderly man from a massive brain hemorrhage after a routine fall suggests that bleeding complications from the recently approved Pradaxa blood clot preventer are largely irreversible, Reuters reports.

TSA defends use of airport scanners that expose travelers to low-dose radiation. A national expert on radiation questioned why the Transportation Security Administration insists on using a type of airport X-ray scanner that exposes travelers to low doses of radiation when the agency already has another type of scanner that poses no known safety risks. TSA's answer: Because it would give the other supplier a monopoly, says a story in USA Today.

Deaths from hospital-acquired bacteria hit historic highs. Federal health officials have called on hospitals, nursing homes, clinics and doctor's offices to work harder to fight the spread of a dangerous bacterial infection that can cause life-threatening diarrhea and other complications, NPR reports. Called Clostridium difficile, or C. diff, it tends to hit people who are taking antibiotics for some other illness, and usually is picked up in a health-care facility.

Photo credit: fda.gov