The Annals of Cardiology No.37 | Heart Failure and Switching Medications
Some time ago, my first patient of the week – let’s call him Mr. Jones – walked in for his twice-a-year appointment. He was fifty-three. He drove an electric BMW i3. He carried an Apple iPhone. There was some wrist and neck bling.
But Mr. Jones had a few other things that weren’t as obvious – heart failure, an implantable cardioverter-defibrillator, coronary artery disease, hypertension, high cholesterol, diabetes, gout. We shook hands, but before I could get a “Good morning” out, he says this:
“I’m feeling good today, Doc, so don’t mess with anything.”
I was tempted to follow his advice. “Good”, for Mr. Jones, meant walking long distances on a flat, and, although he experienced shortness of breath with hills or stairs, he had learned to live with that. He travelled a lot and managed well on tours as long as there weren’t too many inclines.
The trouble was, there was a new heart failure drug on the market, and although I doubted the medication would make him feel much better, research suggested it might make him live longer. I explained that the new pill wouldn’t replace all his heart pills – just one of them, and there was a process in which his old pill was stopped and washed out of his system before introducing the new one. There would be additional office visits, blood pressure checks, and blood tests. He didn’t seem overjoyed by the news. In fact, he looked dejected. He mentioned an upcoming trip to the States to see his daughter, an already-booked Caribbean cruise, and some other pending events. I could tell he was weighing the costs of another adjustment period, more monitoring, side effects, and especially the possibility that the medication wouldn’t agree with him, and he might end up back on his original drug. “Well,” I asked, “what do you say?” His reply: “Uh, not today.”
Mr. Jones is one of many Bermudians living with heart failure. It’s not my favorite term because it sounds like your heart has given up, but that’s not true. The term means that your heart struggles to do what’s asked of it in every circumstance.
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