The heart didn’t know enough to stop”: Insights from patient metaphors about living with cardiac implantable electronic devices


“The heart didn’t know enough to stop”: Insights from patient metaphors about living with cardiac implantable electronic devices

Metaphors conceptualize one idea in terms of another (Lakoff & Johnson, 1980), and can provide insight into how people view their health conditions in the context of lived experience. Importantly, understanding patients’ perspectives through the use of metaphor can improve patient-centered communication (Periyakoil, 2008). This study included interviews with thirteen older adults with cardiac implantable electronic devices (CIEDs), who were part of a larger study with older adults with heart failure (N=24). The purpose of the larger study was to understand how adults with heart failure make decisions about their health and to design a patient-facing technology for heart failure self-management. The interviews took place at a large, non-profit hospital system in the Midwest. During preliminary analyses of the interviews (Daley et al., 2018; Holden et al., 2018), we observed metaphors in the transcripts naturally used by participants when talking about their health. I (CD) conducted a metaphor analysis (Goering, 2015; Schmitt, 2005) on 13 transcripts of participants with CIEDs that revealed themes related to patients’ perceptions of their device and heart functioning. Participants were ages 66-84 (mean 74.2, SD 5.5), 9 males and white. The analysis revealed four metaphoric frames:

  1. The device is overpowering. This frame portrayed a violent or controlling impact from the device: knocked off your feet, hit, whipped, zapped, bolt of lightening, and you’re not gonna outbeat that shock. One participant described the shock as a “loud bang… like someone’s held a gun up to your ear and pulled the trigger.” Another participant explained that his pacemaker “started running me”.
  2. 2. The device’s job is to revive. This frame construed the therapeutic, life-saving aspects of the device positively, such as: “so far that good ole pacemaker has done its job. I got paced back in”; and “it (the device) does a good job… it starts the heart back beating.”
  3. The heart is autonomous. This frame portrayed the heart as a separate being, capable of having its own knowledge and communication: “I don’t know where it (the heart) gets its information from,”; the “right side (of the heart) didn’t know enough to stop”, and “the heart finally told me, we’re gonna create limits to ya..
  4. The heart is a machine. This frame included mechanical terms that were used to describe the heart, such as “pump” and “power” and “operating on 30%”.

Participants’ metaphors suggest that there’s a lack of perceived control concerning device therapy and their heart functioning. Prior interview studies also show that patients feel of loss of control (Morken, Severinsson, & Karlsen, 2010) and stress related to consequences of living with a device (Humphreys, Lowe, Rance, & Bennett, 2016). However, metaphors in this study also revealed participants’ perceptions of the life-saving ability of their devices. In clinical encounters, listening for metaphors that patients use could help clinicians communicate with heightened sensitivity to patients’ perspectives, and enhance their understanding of their device and heart functioning.

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Conference Proceeding

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Publication Title

Kentucky Conference on Health Communication


The authors acknowledge the participants and staff from Parkview Health. This study was sponsored by Agency for Healthcare Research & Quality (AHRQ) grant R21 HS025232. The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ.