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Doctors urged to expand heart-care advice

Dick Cheney, former vice president, has lived with a heart assist device since  2010 and  reported “doing well for now.”

Dick Cheney, former vice president, has lived with a heart assist device since 2010 and reported “doing well for now.”

NEW YORK - A heart device might save lives but leave some people miserable. That 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 do not realize what they are getting into when they agree to a treatment, while doctors assume they want everything possible done to keep them alive, according to the American Heart Association, which published new guidelines Monday that are endorsed by other medical groups.

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The guidelines call for shared decision-making when patients face a chronic condition that often proves fatal and they need to figure out what they really want for their remaining days. If such patients 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, who helped draft the new advice.

One of his former patients is an example: a 74-year-old man too weak to go shopping or walk around his neighborhood. He was so miserable that doctors thought he would feel better with a mini-artificial heart - a $100,000 left ventricular assist device to make his heart pump better.

“Even if it goes well, people are left with an electrical cord coming out of their belly’’ and a higher risk of stroke and bleeding, Allen said.

The man had the device implanted, but suffered problems and spent 10 weeks in the hospital. He and his wife asked to have the pump turned off, Allen said. The man died about a year ago.

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By contrast, Dick Cheney, the former vice president, now 71, has been living with a heart assist device since the summer of 2010 and reported in his recent memoir that he is “doing well for now.’’

Cheney, who had the first of five heart attacks at age 37, proudly shows off the long-life batteries he wears in a vest.

More than 5 million Americans have heart failure, and the number is growing as the population ages.

Failure occurs when a heart becomes too weak - because of a heart attack, high blood pressure, or other condition - to pump enough blood.

Fluid can back up into the lungs, causing shortness of breath, weight gain, and fatigue.

Many high-tech treatments are available for advanced disease. But they usually do not slow its progression.

The new heart association advice urges discussing not just survival gains but also potential problems from devices or treatments, such as side effects, loss of independence, quality of life, and obligations on families and caregivers.

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