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Editor's Choice

Let's call it cardiac impairment

BMJ 2005; 331 doi: (Published 18 August 2005) Cite this as: BMJ 2005;331:0-f
  1. Fiona Godlee, editor (fgodlee{at}

    When a label confuses doctors and impairs communication with patients, it is time to change the label. So say Richard Lehman and colleagues this week in their editorial on heart failure (p 415). They argue that, for doctors, the term “heart failure” covers a confusingly wide spectrum of illness and is something we have difficulty defining, while for patients it can sound like “the end of hope”—something they try to forget or allow to dominate their lives. Either way the result is likely to be damaging psychologically and reduce adherence to treatment. As an alternative name, Lehman et al suggest cardiac impairment.

    The editorial also usefully reminds us that the best basis for defining—why not start now?—cardiac impairment, is B-type natriuretic peptide (BNP). This one-off blood test is a better prognostic marker than even systolic ejection fraction. It may also, the authors suggest, prove useful for detecting people at risk of cardiac impairment, and for sequentially monitoring a patient's response to treatment, providing for the first time a tool for chronic disease management in this common and deadly condition.

    While evidence is accruing for these other potential uses for BNP, trialists in Argentina present a simple and scalable method for managing outpatients with cardiac impairment, which, in this large, inclusive, multicentre trial at least, improved patients' lives (p 425). In fortnightly telephone conversations, trained nurses based at a central point provided education, counselling, and monitoring. The calls focused on how well the patients were adhering to their diet and drug treatment, whether they were taking daily exercise, what their symptoms were, and whether they had signs of salt retention. The nurses were able to adjust the dose of diuretics and refer patients for additional medical visits. The calls reduced readmissions to hospital by about a quarter compared with usual care, as well as improving adherence to treatment and quality of life. The paper doesn't analyse costs, but the intervention looks likely to be highly cost effective.

    The telephone gets less good press from Suzanne McEvoy and colleagues (p 428)—the mobile phone to be exact, and when used in cars to be entirely accurate. We may have thought we knew that using a mobile phone while driving was dangerous. This study puts a figure on how dangerous it is. Drivers interviewed after a crash were four times more likely to have been on the phone when they crashed than during a similar period when they didn't crash. Using hands-free phones was no safer, and the extension of hands-free technology could, by making it easier to phone while driving, increase the number of accidents.

    Will this information stop us making that seemingly essential call while driving down the motorway? And what about those of us who, like Nick Taffinder (p 463), admit to having used our phones while being a patient in hospital? Is there evidence that doing this is dangerous? I would love to know.


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