Patients with slowly progressive heart failure rarely present saying they are breathless. They present saying they are fine, because the adaptation happened faster than the symptom registered. The stairs got taken more slowly, the shopping got split into two trips, the second pillow appeared months ago and nobody wrote it down.
So do not ask whether they are breathless. Ask what they stopped doing this year that they were doing last year, and when. The answer dates the decline in a way New York Heart Association class rarely does, and it gives you something to re-ask at the next visit that is specific enough to have changed.
The same question works in reverse after a treatment change. A patient who says a drug made no difference will often, asked this way, report that the trip to the market is back to one journey.
- Ask what activity has been given up and when, rather than asking about breathlessness
- Record the specific activity in the notes so the next visit has a comparator
- Ask about pillows and about sleeping position changes by date
- Re-ask the same question after a dose change before concluding it did nothing
Why it matters
Functional class is recorded far more often than it is measured against anything.
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