1. Perspective
Heart Failure: Can You Think of a Better Name?
BOB KIRSCH, MA,1
AND BETTY WOLDER LEVIN, PhD2
New York, New York
A 2001 New York Times article by Ben Krull on the ‘‘art’’
of framing nicknames notes something that might have rel-
evance to the names we give to illnesses. The article points
out how ‘‘Joe DiMaggio’s moniker, the Yankee Clipper,
helped those who couldn’t make it to the ballpark envision
the great outfielder chasing fly balls with the grace of a clip-
per ship gliding on water.’’1
How does the moniker ‘‘heart failure’’ help those who
couldn’t make it to organic chemistry, let alone to medical
school, envision their future or that of a loved one diag-
nosed with this extremely serious cardiovascular disease?
Over the past few decades, there have been enormous
strides in the treatment of conditions that produce insuffi-
cient cardiac output. Meanwhile, as the American Heart
Association (AHA) itself acknowledges, for many the label
sounds dire. Indeed, the AHA’s own website for patients
opens the section titled ‘‘About Heart Failure’’ with the
statement, ‘‘The term ‘heart failure’ makes it sound like
the heart is no longer working at all and there’s nothing
that can be done.’’2
Under the heading ‘‘Does Your Heart Stop?,’’ another page
on the AHAwebsite explains, ‘‘When you have heart failure,
it doesn’t mean that your heart has stopped beating.’’3
The Heart Failure Society’s website for patients states,
‘‘Many people mistakenly believe that heart failure means
that the heart has stopped or is about to stop.’’4
The patient-education segments of the websites of both
the US National Heart Lung and Blood Institute at the
National Institutes of Health (NIH) and the Centers for
Disease Control and Prevention also reflect the need to
counter implications broadcast by the word ‘‘failure.’’
Both of their patient education sections explain, ‘‘Heart
failure does not mean that your heart has stopped or is
about to stop working.’’5,6
With increased recognition of the importance of patients’
understanding of their conditionsdand of better self-
management leading to better medical outcomes, lower health
care costs, and improved quality of lifedis it not time, as
othershave noted,toconsiderchangingthename to something
thatdoes not suggest suddendeath oran unyieldinglifeofmis-
ery?7,8
In particular, we might wish to inquire about the impact
ofthecurrentnameforthemanyheart failurepatientswhosuf-
fer comorbid depression?
As the science has changed, so the namedand its
messagedshould change. Yet the burdensome name we
pronounce is the same name that was current when treat-
ment options were fewer, a time when, for example, Paul
Dudley White wrote in the 1946 edition of his textbook
Heart Disease, ‘‘To estimate an average duration of life af-
ter the onset of congestive failure is misleading because of
the great variations that exist, but the severity of the condi-
tion in general is shown by the fact that such an average is
but a few years.’’9
For many patients, 60 years of investiga-
tive clinical experience have made White’s uniformly
gloomy prognosis irrelevant.
Not many decades ago, a physician could simply avoid
using the term ‘‘heart failure’’ in speaking with patients.
‘‘Patients do not like to be told that they have heart failure.
They are often terrified by the term because they believe it sig-
nifies that death from cessation of the heartbeat must be immi-
nent. The wise physician avoids using the words heart
failure,’’10
states the medical textbook The Heart: Arteries
and Veins(1982), editedbyJ.Willis Hurst,inthe section titled,
‘‘Words that Alarm the Patient.’’ But now, patients demand
more information, and many do their own investigations on
theinternet. Perhaps itistimetotakeDrHurst’s advicetoheart
in a larger sense; perhaps it is time for the community of phy-
sicians to banish the term ‘‘heart failure’’ while explaining far
and wide why the old terminology merited exile.
Notably, cardiologists are not the only physicians con-
sidering such a change of name. A 2009 NIH state-of-
the-science conference, Diagnosis and Management of
Ductal Carcinoma in Situ (DCIS), concluded that ‘‘strong
consideration should be given to remove the anxiety-
producing term ‘carcinoma’ from the description of
DCIS.’’11
One may wonder about the effects of anxiety-
producing medical terms on patient adherence to physician
recommendations.
From the 1
Metropolitan New York Chapter of the American Medical
Writers Association, New York, New York and 2
Brooklyn College and the
CUNY School of Public Health, New York, New York.
Manuscript received December 5, 2011; revised manuscript accepted
January 6, 2012.
Reprint requests: Bob Kirsch, 115 Somerstown Rd, Ossining, NY
10562. E-mail: bk292@columbia.edu
See page 174 for disclosure information.
1071-9164/$ - see front matter
Ó 2012 Elsevier Inc. All rights reserved.
doi:10.1016/j.cardfail.2012.01.004
173
Journal of Cardiac Failure Vol. 18 No. 3 2012

2. As Bill Clark, M.D., past president of the American
Academy on Communication in Healthcare has explained
(personal communication, October 26, 2011), ‘‘evidence
abounds showing that how information is presented, includ-
ing the words chosen, has a profound impact on health out-
comes; acting mostly through the medium of patient
adherence to instructions about diagnostic procedures and
treatments.’’
What might the new name be? The disease might be
named for some great late nineteenth or early twentieth
century physician (following the model of Alzheimer dis-
ease). Such a name does not circumscribe the complexity
of the disease while it leaves unlimited room for individual
physicians to use clinical judgment in characterizing the ill-
ness to individual patients.
Or perhaps the name should be some variant of cardio-
vascular pumping disorder (CPD). However, the purpose
of this commentary is not to suggest a specific name but
rather to clarify the importance of selecting a name that
would be less frightening to patients and more helpful to
physicians trying to motivate their patients to do the right
thing.
The purpose of the present commentary is to suggest that
there might be a link between reinterpreting the patient’s
medical world and changing the patient’s feelings about
her or his world, and that feelings help motivate actions.
With the change of name would come the opportunity to
explain to patients, families, and the public why the old
name was abandoned. So the explanation would start with
nothing more than, ‘‘We changed the name.’’ That is a sim-
ple message, a clear message. It is a message many patients
can take home with them and build upon.
‘‘Why did we change the name? Because we want you,
the patient, to understand that for many patients the word
‘failure’ no longer fits. We want you to understand that
things are very much more hopeful now.’’
For many patients, but certainly not for all, the physician
might then add something like the following statement:
‘‘Millions of patients with this disease are doing their
part to help manage the illness and are now living longer,
happier, healthier lives. You can make a difference. If you
work with me and your other doctors, we can form
a team and achieve some degree of success for you.’’
That is a simple story. It is a story almost everyoned
patients, families, friends, and the general publicdcan
readily grasp. No fancy scientific terms. No discouraging
words.
It is a story that gives meaning to the steps the patient
takes toward health by transforming patients into partici-
pants in a powerful narrative. Within this narrative, they ex-
perience ‘‘challenge, hope, and choice.’’12,13
Abandoning the name ‘‘heart failure’’ might potentially
yield benefits related to prevention, early diagnosis, and
patient adherence to physician recommendations, as well
as to the attitudes of caregivers and of people within pa-
tients’ personal support networks.
A change of name might create a teachable moment: an
opportunity, based on clinical judgment, to motivate with
words less likely to lead patients to feelings of fear, despair,
and isolation and more likely to mobilize feelings of en-
couragement, hope, and commitment.
Acknowledgments
For helpful suggestions, the authors acknowledge and
thank Don DeKoven, Marvin A. Konstam, MD, Gregg C.
Fonarow, MD, Mary Kirsch, and Melissa Gordon, PhD.
Disclosures
None.
References
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174 Journal of Cardiac Failure Vol. 18 No. 3 March 2012