Now, doctors have become so good at caring for heart attack patients that many fewer die.

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Wayman's own mother died of a heart attack while caring for Wayman's father.

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According to an AHA online survey, the top two reasons women defer heart surgery is "caring for others, " and "family responsibilities, " said Dr. Rakesh Suri, a consultant in the division of cardiovascular surgery at the Mayo Clinic.

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Dr. Shabbir Hossain described caring for a woman as an outpatient whose congestive heart failure recurred shortly after hospital discharge.

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His answer is a greater transparency, a "duty of candour", and an emphasis on compassion at the heart of the so-called "caring services", especially nursing.

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The 38-year-old spent years caring for her seriously ill daughter Emily, 10, who was born with heart problems and had to be fed through a tube in her stomach.

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The failure to do so after the first of the 21-sickle cell related deaths over the past decade and other heart-related deaths cannot objectively be explained away without serious doubt about whether there was sufficient caring and action at a high level for those student athletes.

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