Let’s talk chronic heart failure

We applaud CMAJ’s efforts at medical education via their “Five things to know about …” series. However, we believe that a recent paper by Moayedi and Kobulnik1 falls somewhat short.

Specifically, heart failure is predominantly a disease of the elderly.2 Elderly patients are often not candidates for mechanical circulatory support or cardiac transplantation. Although there are options such as cardiac resynchronization devices and implantable cardioverter defibrillators, the benefits of these therapies may be attenuated in the elderly.3 Therefore, we are generally left with medical management options for this patient population.

Although the authors point out that there are some promising new medications on the horizon, at present, patients with heart-failure face five-year mortality rates of about 50%.2 This prognosis is worse than that of many patients with cancer.4 Despite this, physicians rarely encourage advance-care planning or discuss goals of care with their patients with heart failure.5 The Choosing Wisely Canada initiative recommends not delaying these conversations.6 We need to start having these discussions with our patients with heart failure. What better way to do this than to include it in your “five-things-to-know-about-heart-failure” list?