If you were suddenly diagnosed with heart failure, you would first of all be utterly horrified by hearing those words “heart failure” – which brings me to the eternal question: when are cardiologists going to come up with a better name for this common condition in which a person’s heart has trouble pumping blood as well as it should? (See also: “When Doctors Use Words That Hurt“)
I hope that the second thing that happens after you hear those dreadful words is that somebody will immediately show you this beautiful photo (above) of twin sisters Shaun Rivers and Kim Ketter, both nurses from Richmond, Virginia. They were each diagnosed with heart failure during the same week in 2009 when the twins were just 40 years of age.
Now compare the twins’ photo (and its accompanying text from the American Heart Association) with something that I hope you will never, ever see upon hearing that frightening diagnosis:
This was posted on Twitter by Canada’s Heart and Stroke Foundation. The in-your-face approach typifies what author Michelle Landsberg once described as “our annual scolding from the Heart and Stroke Foundation.”
You may recall their controversial 2011 “Make Death Wait“ fundraising campaign about women’s heart disease. In those ads, death (bearing a man’s raspy and menacing voice) declares his love for women – older women, professional women, stay-at-home Mums – while stalking random women doing regular day-to-day activities and threatening things like: “You have no idea that I’m coming after you.” As Marketing Magazine observed at the time, many people found that ad spot hard to watch. The Heart and Stroke Foundation’s vice-president of marketing and communications for Ontario defended the campaign by explaining:
“We needed a message that was really going to hit people over the head with a two by four.”
Not surprisingly (at least to anybody who has worked with Big City advertising agencies), Lowe Roche, the Toronto ad agency that created that 2011 campaign, claims that it garnered “phenomenal results,” including a 20% increase in donations to the Heart and Stroke Foundation.
When I contacted the Heart and Stroke Foundation last month about their newest heart failure = death and disability messaging, I was told that the poster – and others like this cheerful one on the right showing a man slumped on a park bench, apparently waiting to die – were developed for their 2016 Report on the Health of Canadians: The Burden of Heart Failure. So far, HSF has not yet responded to my February 22nd follow-up request asking who their target market is for these images/messages, and if they had anticipated the reaction of those actually living with heart failure upon seeing them.
This comprehensive HSF report is depressing to read. Speaking of which, only one paragraph about depression linked to a heart failure diagnosis is included in the 12-page report. (After eight full pages, however, the report does concede that “people can learn to live active, healthy lives” even with a heart failure diagnosis).
But significantly under-reported is the fact that new-onset depression is common among those diagnosed with heart failure, affecting up to 40% of all such patients. As described by the European Society of Cardiology at last year’s conference, depression as a direct result of hearing this diagnosis is associated with:
- loss of motivation
- loss of interest in everyday activities
- lower quality of life
- loss of confidence
- sleep disturbances
- change in appetite with corresponding weight change
This depression-associated reality is important because we know that heart patients suffering from such symptoms are far less likely to take their prescribed meds, exercise, change their diet, show up for medical appointments and cardiac rehabilitation classes, quit smoking, lose weight, or be able to manage their considerable chronic stress.
Ironically, the lifestyle improvements listed above are precisely what the same physician who first drops the diagnostic bomb “heart FAILURE” upon them will likely be recommending in the very next breath. Depression is, in fact, associated with a five-fold increased mortality risk for heart patients. See also: “When Are Cardiologists Going to Start Talking About Depression?“
No wonder those men slumped in the wheelchair or on that bench look so awful! If you knew your heart were “failing” and you’re headed to your own funeral, you’d feel depressed and awful, too. And if you weren’t depressed when you started reading this report, you certainly would be by the time you finished it.
Try to imagine for a moment how this “no cure” campaign makes existing or freshly-diagnosed heart failure patients feel. And what other words might our doctors use to replace the hurtful words “heart failure”? The late and legendary pioneer cardiologist Dr. Bernard Lown answered that question in this way:
“Heart failure is not a disease. It’s just a description of clinical syndromes. A heart failure prognosis is no longer what it used to be; much of the damage that occurs to the heart may be reversible and the symptoms controlled over decades.
“Perhaps a better term would be stiff muscle syndrome.”
Dr. Lown also suspects that instilling anxiety by deliberately using alarmist language like heart failure is sometimes what otherwise caring physicians may do in order to convey a sense of urgency, thus hoping to ensure that patients will comply with lifesaving recommendations. Even in non-emergency situations, he says, the physician may believe that these words are actually necessary to persuade the patient to accomplish what needs to be done to maintain health. But ironically, the very opposite outcomes frequently happen.
So, given the choice between the American Heart Association’s twin sisters and the Heart and Stroke Foundation’s old-dying-guy-slumped-on-bench-or-in-wheelchair images, which of these two awareness campaigns would you find most compelling?
Which one would motivate you to learn more about a serious health condition?
Which poster would you put up on your staff room bulletin board?
Which non-profit organization would you be more likely to support with your donation dollars?
I’ll help you decide. Here’s an AHA excerpt describing how Shaun and Kim are responding to their respective heart failure diagnoses:
“The sisters have joined a newly established team of American Heart Association Heart Failure Patient Ambassadors. The group offers support by sharing their personal experiences and information with the millions of Americans impacted by heart disease and stroke.
“Kim and Shaun also shared their story at The Saint Paul’s Baptist Church, having launched the AHA’s EmPowered To Serve initiative there three years ago. The program aims to improve health in multicultural communities by partnering with faith-based organizations.
“Along with providing medical care, the sisters have worked with church leadership to include healthier choices on the church café’s menu, such as baked or grilled chicken, fish and fresh vegetables. As Kim explained:
“We have people come and thank us because they had no idea they had a health problem. We’re ensuring spiritual health, but also the physical health of our congregation. It’s a huge responsibility, but we’re living our life with purpose.”
Thank goodness Shaun and Kim didn’t get the memo reminding them that the grim H&SF reaper is hovering right outside their bedroom windows. Nor did the lively senior (also living with heart failure) who stands next to me in the back row of the gym during our Friday morning weight training classes. Too bad the Heart and Stroke Foundation didn’t choose to include a nice black and white illustration of her working out, or other heart failure patients living their lives and not just resigned to dying. . .
So there’s your choice: learn from, share and support an awareness and information campaign that features active patients like the twins, or put up the poster of the grey patients slumped in wheelchair or park bench, sitting around praying for a merciful death.
My question now to the Heart and Stroke Foundation about publicizing these images:
What were you thinking?
While we’re contemplating the possible answer to that query, please consider removing those grim messages from the 2016 report, and stop sharing the images on social media as if you believe they are somehow helpful to heart patients. They are not.
And while we’re all waiting for that, below are some non-inflammatory basics I call “Heart Failure 101″. These facts won’t make patients want to slit their wrists if they happen to be among the 50,000 Canadians who are diagnosed with heart failure each year.
And no two by fours are required to understand them. . .
What is Heart Failure?
The heart is a muscle that works like a pump. Its main job is to pump blood throughout your body.
Heart failure occurs when your heart is no longer strong enough to provide your body with all the blood and oxygen it needs. This happens because your heart has become damaged or weakened. When this occurs, your heart works harder than normal and less efficiently. This increased effort can cause physical changes in the heart over time, such as thickening of the walls of the heart.
Heart failure does NOT mean that your heart will suddenly stop working or that you are about to die. It means that your heart has to work harder to keep the blood flowing to the rest of your body. It means the heart does not pump as well as it should. It’s sometimes known as congestive heart failure, and is the leading cause of hospitalization in people older than 65.
Cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic, adds that the type of heart failure most commonly seen in women — known as heart failure with preserved ejection fraction — is caused by problems when the heart relaxes between beats, leading to elevated blood pressure that can cause the heart to stiffen.
What causes Heart Failure?
How is Heart Failure treated?
Sources: Mayo Clinic, Cleveland Clinic, Ottawa Heart Institute, National Heart Lung & Blood Institute
Q: Can you think of better alternatives to using the term “heart failure”?
2016 Report on the Health of Canadians: The Burden of Heart Failure – the Heart and Stroke Foundation report