Language Matters -Representations of ‘heart failure’ in English discourse: a large-scale linguistic study

Abstract Aims Heart failure (HF) has a lower public profile compared to other serious health conditions, notably cancer. This discourse analysis study investigates the extent to which HF is discussed in general contemporary English, UK parliamentary debates, and the ways in which HF is framed in discussions, when compared to two other serious health conditions, cancer and dementia. Methods The Oxford English Corpus of 21 st century English-language texts (2 billion words) and the UK Hansard Reports of parliamentary debates from 1945 to early 2021 were used to investigate the relative frequencies, contexts of use of the terms ‘heart failure’, ‘cancer’ and ‘dementia’. Results In the Oxford English Corpus, the term ‘heart failure’ occurs 4.26 times per million words (pmw), ‘dementia’ occurs 3.68 times pmw and ‘cancer’ occurs 81.96 times pmw. Cancer is talked about 19 times more often than HF and 22 times more often than dementia. These are disproportionately high in relation to actual incidence: annual cancer incidence is 1.8 times that of the other conditions; annual cancer mortality is twice that caused by coronary heart disease (including heart failure) or dementia. ‘Heart failure’ is used much less than ‘cancer’ in UK parliamentary debates(House of Commons and House of Lords) between 1945 and early 2021, and less than ‘dementia’ from 1990 onwards. Moreover, HF is even mentioned much less 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 0.28 times pmw. Discussions of HF are comparatively technical and formulaic, lacking the survivor narratives that occur in discussions of cancer. Conclusions HF is under-discussed in contemporary English compared to cancer and dementia. HF is also under-discussed in UK parliamentary debates, even compared to the less-obviously life threatening topic of potholes in roads and pavements. What is already known on this topic Heart failure is a serious health condition with significant morbidity and mortality, which is comparable to other serious health conditions such as cancer. What this study adds Our study has shown that heart failure is less frequently discussed in contemporary English as well as in UK parliamentary debates in comparison to other serious health conditions such as cancer and dementia, despite comparably significant adverse outcomes and also that discussions regarding people with heart failure are less empowering in comparison to discussions regarding cancer. How this study might affect research, practice or policy? Results of this study should motivate all stakeholders involved in heart failure to redouble their efforts to spread awareness regarding the seriousness of the condition in general discourse as well as to engage parliamentarians better and thereby exert influence upon commissioners to significantly improve investment in prevention, early diagnosis and better management of heart failure.