Serious thought on heart care devices urged

A heart device might save your life but leave you miserable. That awful possibility is the reason for new advice urging doctors to talk more honestly with people who have very weak hearts and are considering pumps, pacemakers, new valves or procedures to open clogged arteries.

Too often, patients with advanced heart failure don't realize what they are getting into when they agree to a treatment, and doctors assume they want everything done to keep them alive, says the new advice, published yesterday by the American Heart Association.

It calls for shared decision-making in facing a chronic condition that often proves fatal and patients need to decide what they really want for their remaining days. If they also have dementia or failing kidneys, the answer may not be a heart device to prolong their lives.

"Patients may feel that the treatment was worse than the disease," said Dr. Larry Allen of the University of Colorado Anschutz Medical Center.

By contrast, former Vice President Dick Cheney, 71, has been living with a heart assist device since the summer of 2010 and reports "doing well for now . . . I've gotten used to the various contraptions that are always with me."

But more than 5 million Americans have heart failure, and the number is growing as the population ages. The heart association advice includes an annual talk between patients and doctors to set treatment goals and for possible emergencies such as cardiac arrest.

Mary Jane Eaton has thought it through. She's 80 and lives in Aurora, Colo., just east of Denver. Twenty years ago, she had a heart valve put in, but it's leaking now. She has heart failure and chest pains, probably from clogged arteries.

After talks with her cardiologist, Dr. Jennifer Dorosz, she has decided to treat her fluid buildup with higher doses of water pills and not have any more tests or surgery.

"I can't see that I could go through that," Easton said. "At my age, I just figure you know what, when the Lord's ready for me, he's going to take me. And I don't want to be taken on the operating table."