Language Matters:representations of 'heart failure' in English discourse-a large-scale linguistic study

Aims: Heart failure (HF) has a lower public profile compared with 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 with two other serious health conditions, cancer and dementia. Methods: The Oxford English Corpus (OEC) of 21st 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 and use of the terms ‘heart failure’, ‘cancer’ and ‘dementia’. Results: In the OEC, 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 two times that caused by coronary heart disease (including HF) 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 pot-holes in UK roads and pavements. In 2018, for example, ‘pot-hole/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 survivor narratives that occur in discussions of cancer. Conclusions: HF is underdiscussed in contemporary English compared with cancer and dementia and underdiscussed in UK parliamentary debates, even compared with the less-obviously life-threatening topic of pot-holes in roads and pavements.