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

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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.

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