Heart failure deemed less important than potholes in public discourse

Heart failure, a serious condition that affects millions of people worldwide, is deemed less important than potholes in roads and pavements, on the evidence of its role in public discourse, finds research published in the open access journal Open Heart.

Yet the condition is as serious as dementia and cancer, say the researchers. And major efforts are now needed to raise its profile and ensure it gets equal billing in health policy and future investment.

Around 65 million people around the globe are thought to have heart failure, but this figure is projected to rise steeply as a result of ageing populations and more effective treatments for, and survival from, coronary artery heart disease and high blood pressure.

Heart failure is associated with poor quality of life and frequent hospital admission: 1 in 5 people with the condition will be readmitted to hospital within 30 days of discharge. 

Survival prospects are relatively poor: 27% of people will die within 2 years of diagnosis, rising to 43% within 5 years, and 65% within 10 years.

And heart failure eats up 1–2% of the annual healthcare budget in Europe and the USA, with hospital care taking the lion’s share of the costs.

Despite its personal and financial impact, it has not received anything like the recognition, and therefore policy initiatives and funding, of other serious health conditions, such as cancer, point out the researchers.

The use of computer-assisted analysis of language in large bodies of text has proved useful to understanding how people think and feel about serious health conditions, they say. 

They therefore wanted to apply the same technique to heart failure, to find out the extent to which heart failure is discussed in general contemporary English and UK parliamentary debates, and how this compares with other serious health conditions, such as cancer and dementia.

They also wanted to compare the frequency of references to heart failure in UK parliamentary debates with those to a rather less life-threatening topic—potholes in UK roads.

They drew on The Oxford English Corpus (OEC) of 21st century English-language texts, numbering 2 billion words, and the UK Hansard Reports of parliamentary debates from 1945 to early 2021 to find out the relative frequencies, contexts, and use of the terms ‘heart failure’, ‘cancer’ and ‘dementia’.

The analysis showed that the term ‘heart failure’ occurs 4.26 times per million words (pmw) in the OEC; ‘dementia’ occurs 3.68 times pmw and ‘cancer’ occurs 81.96 times pmw.

Cancer is talked about 19 times more often than heart failure and 22 times more often than dementia. These figures are disproportionately high in relation to actual incidence, say the researchers.

The number of new cases of heart failure and dementia in the UK are not dissimilar, at 200,000 and 209,600/year, respectively, as are the number of annual UK deaths caused by each disease: 64,000 and 66,424, respectively.

The number of new cases of cancer is nearly twice as high as that of the other conditions, while annual deaths are twice as high as those caused by coronary heart disease (including heart failure) or dementia. 

The term ‘heart failure’ cropped up much less often than ‘cancer’ in UK parliamentary debates between 1945 and early 2021, and less often than ‘dementia’ from 1990 onwards, to the extent that the term was practically invisible.

What’s more, heart failure was even mentioned much less often than potholes in UK roads and pavements. In 2018, for example, ‘pothole/s’ were mentioned over 10 times pmw—37 times more often than ‘heart failure’, mentioned just 0.28 times pmw. 

Discussions of heart failure also tend to be comparatively technical and formulaic in nature, lacking the personal experience narratives that occur in discussions of cancer, the analysis showed. And ‘heart failure’ was also typically associated with the word ‘died’. 

The researchers acknowledge that there was a debate on patients with heart failure in the UK House of Commons in March 2021, which was not accessible at the time of the study, so wasn’t included.

And as well as causing general frustration and inconvenience, potholes do pose some threat to health and quality of life, they add. But although potholes aren’t trivial, they “are arguably less important and urgent,” the researchers point out.

“If we take frequency of mentions as an indicator of importance, the topic of [heart failure] has been much less important in UK parliamentary debates in recent years than even potholes in roads and pavements,” they comment.

“It is crucial that all stakeholders involved in [heart failure] redouble their efforts to spread awareness regarding the seriousness of the condition and the pressing need to significantly improve investment in prevention, early diagnosis, and better management,” they conclude.