Heart failure (HF)—also known as congestive heart failure—has traditionally been a gut-wrenching diagnosis because it gets worse over time and there is no cure.
Now, with new treatment approaches and a greater emphasis on lifestyle changes, people with HF are enjoying longer, more vital lives than ever before.
A caveat: Even as progress is being made, doctors acknowledge that there’s an alarming trend in the rate of older adults affected by HF. About 6.5 million people in the United States (most of them age 65 or older) have HF.
While the older population has substantially increased in recent years, deaths from some types of heart disease, such as coronary artery disease, which leads to heart attacks, have declined. The number of people with HF, however, has increased. As a result, deaths from this condition have jumped by 38%, according to an important 2019 report published in JAMA Cardiology. Even though age is a leading risk factor for HF, cardiologists believe that getting more people to follow effective prevention strategies is the key to reversing this troubling trend.
The term heart failure may sound like your heart has stopped or is about to stop working, but it actually means that your heart has been weakened, making it harder for this life-giving organ to pump blood throughout the body.
HF can develop when the heart becomes damaged by any of a number of heart conditions, such as high blood pressure (hypertension), type 2 diabetes, ischemic heart disease (marked by a buildup of plaque in the coronary arteries), heart valve disease, and arrhythmia (an abnormal rate or rhythm of the heartbeat).
Over time, these conditions can cause your heart to enlarge or stiffen, slowing down the flow of blood throughout your body. This process can take days if an acute heart condition (such as heart attack) occurs, or it may take years or even decades when a chronic risk, such as hypertension, is present.
When the heart muscle is affected by these risk factors, the heart pumping ability is reduced and fluid builds up in your ankles, feet, and legs—a condition called edema.
Fluid may also back up in the lungs, leading to shortness of breath. Thus, the main symptoms of HF
are shortness of breath, fatigue,
and edema.
Even though HF is irreversible once it develops, the prognosis is no longer so grim. In fact, more times than not, it is now hopeful.
The improved outlook is largely due to doctors’ deeper understanding of when and how newer and older medications can be combined to fit the needs of individual patients. The older pharmaceutical stalwarts (including diuretics, ACE inhibitors, beta blockers, and digoxin) help reduce fluid buildup, ease shortness of breath and, by lowering blood pressure, ease strain on the heart and slow the heart rate—all of which help the heart beat stronger. Among the newer medications are ivabradine (Corlanor), which slows heart rate, and sacubitril/valsartan (Entresto), which relaxes blood vessels, making it easier for your heart to pump blood to your body. It may also reduce scarring (or fibrosis)—a benefit that, if confirmed, would be a new target for therapies. Both medications must be used precisely, and national guidelines have been established by professional societies.
When used correctly, both medications have been shown to reduce the risk for hospitalization due to HF (by 18% and 21%, respectively) compared with standard treatment alone. Entresto has been shown to lower the risk for death by about 20%. The combination of the legacy therapies and these new therapies—with more on the way—has fueled hope that the tide may be turning with regard to HF.
Surgeries and medical devices also are extending the lives of people with HF. These include heart bypass surgery if a blocked heart artery is causing HF, replacing a heart valve that causes HF, and implanting pacemaker and defibrillator devices to prevent dangerous abnormal heart rhythms associated with HF.
Left ventricular-assist devices (LVADs) are life-saving, implantable, mechanical devices that can help your heart pump. For advanced HF, LVADs can sometimes be used in place of a heart transplant. For the most severe cases, however, heart transplant is still an option.
If you already have been diagnosed with HF, controlling risk factors will also help you live longer. Many of these steps may sound familiar, but the key is doing them. The JAMA report states that the biggest areas of concern are type 2 diabetes, high blood pressure, and obesity.
Use the following strategies to reduce your risk for HF—and live better if you already have it.
Avoid fast foods, convenience foods, processed foods, trans fats, added sugars, and saturated fats.
If you have HF, your body is likely to retain water, and a high-salt intake will make you retain even more. Work with your team of providers for specific advice on a diet and lifestyle that will work for you.
If you have HF and moderate exercise makes you short of breath, ask your doctor about cardiac rehabilitation, a medically supervised program of exercise training and counseling on heart-healthy living. The good news is that cardiac rehabilitation is usually covered by insurance.
