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Marilyn A. Winkleby, PhD, MPH, says it happens all the time. She sits in with her focus group for low-income moms, to train them about health issues, and the participants have no idea they are at risk of heart disease.
They have received other messages loud and clear — such as the need to immunize their children and how to avoid the spread of AIDS. "These are the things that have been made a priority," says Winkleby, a researcher at the Center for Research and Disease Prevention at Stanford University School of Medicine in Palo Alto, CA.
They have seen the advertisements on the sides of buses and heard the public service messages on the radio and can go into great detail on what they should know, which they should be able to do.
"But when you tell them that heart disease is what they will most likely die of, they can’t believe it," she says. "We’re just at that stage of information."
Winkleby says a colleague of hers believes part of the problem is the way heart disease is portrayed in advertisements for drugs that treat different cardiac conditions. There is no sign of suffering or loss in quality of life. It’s all photographs of vibrant couples — men and women in their 50s and 60s who just need to take a pill and everything gets better. "We’ve made it a nice and pretty disease," she says.
"Death comes suddenly. It’s peaceful."
Similarly, at the Centers for Disease Control and Prevention (CDC) in Atlanta, Janet B. Croft, PhD, says the CHF deaths she sees are not as simple as the general public may think. "It’s such a miserable, slow death," she says, recalling how people can slowly suffocate or be so weak they are too tired to finish a meal.
People need to know this is not a natural way live out the rest of one’s years, says Croft, a researcher from the CDC’s cardiovascular health branch.
"If it happened to younger people, more people would sit up and take notice. But since patients are older, people can be saying, It’s natural. Older people should die.’ But it really isn’t natural," she explains.
Croft says a good comparison to use is this: Research shows a healthy person who turns 65 can be expected to live about 9 to 17 more years. But her recent study showed a third of the 67-year-olds being discharged from their first CHF hospitalization will die within a year. In six years, fewer than 25% of women and less than 20% of men will still be alive.
And of course, that doesn’t even count all the people who did not survive long enough to make the study age, or who already had been hospitalized more than once. (See related story, p. 55, for more information.)