The term is heart failure — but it may also be aptly described as an action: The heart is failing. A normally chronic, irreversible and progressive condition, heart failure arises when the weakened heart muscle isn’t able to pump all the blood, which contains oxygen and nutrients, a body’s cells need.
Usually those with heart failure have other serious cardiovascular issues, such as high blood pressure, coronary artery disease or have had a heart attack that led to the ongoing heart condition; patients tend to be advanced in age, often in their 80s, with multiple chronic health issues. So, in addition to widespread issues that affect heart health, such as obesity and diabetes, improvements in care that allow those with cardiovascular issues to live longer, as well as an aging population worldwide, have contributed to a rise in the number of people who have heart failure.
While treatment strides have been made against the chronic condition, experts say factors ranging from the average patient’s advanced age and deteriorating health to inconsistent access to health care are undercutting improvements in survival rates worldwide. What’s more, top heart failure doctors say patients often don’t receive the suggested standard of care, which can significantly lower the rate of survival and undermine quality of life for those living with heart failure. Such concerns have galvanized cardiologists and other health providers around the globe to rally toward improving care and outcomes for the roughly 26 million people on the planet who currently have heart failure. That includes about 6 million in the U.S., a number that’s expected to increase to nearly 8 million by 2030, according to the American Heart Association.
“One of the things that I think is so striking and notable here is that we have a number of therapies that really can markedly improve outcomes for patients with heart failure,” says Dr. Gregg Fonarow, AHA spokesman and professor of cardiovascular medicine at the University of California–Los Angeles. Those range from medications, like ACE inhibitors, to devices that help the heart keep pace with its blood-pumping responsibilities. “But despite the evidence, despite the guidelines, despite the educational efforts, there’s still a large number — hundreds of thousands of patients in the United States — not receiving one or more of these guideline-recommended, evidence-based therapies,” Fonarow says.
Worldwide, survival rates for patients with heart failure are worse than for many major cancers, such as breast and prostate cancer. “Globally, between 17 to 45 percent of patients admitted to [the] hospital for HF will die within one year, according to data published between 2010 and 2015,” says Stefan Störk, scientific director of the Comprehensive Heart Failure Center in Würzburg, Germany, in an email. “Data for [the] U.S. vary between 25 to 35 percent; data for Europe vary between 17 to 30 percent.”
With improved treatment, the U.S. heart failure-related death rate had been declining since 2000, but it began increasing again more recently from an age-adjusted rate of about 81 deaths per 100,000 Americans in 2012 to 84 deaths per 100,000 in 2014, according to the Centers for Disease Control and Prevention. While the number of younger people with heart failure is decreasing, there’s been an increase in older adults getting heart failure and dying from the condition. The trend is owed to an aging population — and the heart failure-related death rate is still well below the rate of about 105 deaths per 100,000 people in 2000. Even so, Fonarow says that based on the latest available data, an estimated 68,000 additional deaths from heart failure could be prevented each year if all patients with the condition were treated according to the national standard of care. “[These are] lives that could have been saved,” he says. “Deaths that did occur that could have been prevented.”
Multiple studies have shown that evidence-based medicines are far underutilized to treat heart failure, says Dr. Randall Starling, head of the heart failure section at Cleveland Clinic. “I think that in and of itself is the low-hanging fruit.” As such, the AHA is involved in international efforts to improve heart failure treatment and outcomes, and in October, top doctors in Europe, including leaders from the Heart Failure Association of the European Society of Cardiology and 36 national heart failure societies, formally announced a partnership pledging “united action to improve patient outcomes and reduce the burden of heart failure on society.” Cardiologist Gerasimos Filippatos, HFA president, called on all countries to make tackling heart failure a health priority. To date, 49 national heart failure working groups from Belgium and Brazil to Estonia and Egypt have signed a white paper to join a global heart failure awareness program. The U.S. is not among those countries, though Fonarow emphasized AHA’s ongoing focus on not only improving guideline-based care domestically but around the world.
Experts note that despite the strides made against heart failure, more can and needs to be done. “For the majority of patients, there are new drugs and there are new devices that we could use to improve both survival and quality of life,” Filippatos wrote in an email. That includes a medication called Entresto, made by Novartis, which was approved by the Food and Drug Administration for the treatment of heart failure in the U.S. and Europe last year.
“This new medication that can replace the ACE inhibitor lowers mortality an additional 20 percent and could add an extra year of life or more to heart failure patients treated with it,” says Fonarow. As with any treatment, experts say it’s important to talk to a physician about possible harms and side effects associated with the medication, which range from low blood pressure and dizziness to hyperkalemia, or high potassium, and poor kidney function. Most patients who participated in clinical trials evaluating the medication were also taking other approved heart failure treatments, according to the FDA, including beta-blockers, diuretics and mineralocorticoid antagonists. Those taking an ACE inhibitor were cautioned to stop taking this and not take Entresto for at least 36 hours if switching to the latter drug to avoid any issues from taking the two together; and pregnant women are advised not to take Entresto. The drug is expected to cost about $4,500 for an annual supply, compared with less expensive generics.
In addition to medication, says cardiologist Andrew Clark, past chair of the British Society for Heart Failure, in an email to U.S. News: “Recent years have seen the widespread uptake of interventions such as cardiac re-synchronisation therapy (a kind of pacemaker-based therapy) and defibrillators.” Abroad, as in the U.S., experts say these therapies can increase survival rates and improve quality of life for patients who are candidates for the treatment — and that being treated by clinicians on the cutting edge, who are familiar with the latest research on heart failure therapies, can significantly improve outcomes.
Also, early detection saves lives and can lead to improved quality of life with treatment. “Patients with new-onset heart failure often respond quite well with guideline-directed medical therapy, and after six to nine months on target doses of medications, there is substantial improvement in the heart muscle function,” says Starling, who is also a member of the American College of Cardiology and AHA, as well as a fellow of the European Society of Cardiology and its Heart Failure Association. Though heart failure is characteristically a chronic condition, he also notes, “Some heart-rhythm disorders can cause a weak heart muscle that can be improved or even completely reversed with treatment. Some patients with blocked arteries develop a weak heart muscle that improves with more blood flow after a stent or bypass.”
Here’s a beat on what some top heart failure experts worldwide say people with the condition can do today to improve their longevity and quality of life:
— Seek medical attention ASAP if you have concerns. According to the AHA, one sign or symptom may not be cause for alarm. But particularly if you experience more than one of the following, which together could indicate you may have heart failure, tell your doctor: shortness of breath, persistent coughing or wheezing, buildup of excess fluid in tissues — such as swelling in feet or ankles — feeling tired all the time, lack of appetite or nausea, having difficulty thinking or memory loss, and increased heart rate.
— Find your own heart failure A-team. “In a fragmented health care system with variable providers, it’s very easy for certain therapies to get overlooked,” Fonarow says. Whether determining a medication regimen or making lifestyle modifications, including exercise and diet, treatment for a person with heart failure is an involved affair. And it takes a village of practitioners specialized in treating heart failure to deliver optimal care, from cardiologists and nurses to registered dietitians. That makes picking the right hospital and health team critically important. Certain online resources, including the Centers for Medicaid & Medicare Services’ Hospital Compare, evaluate how well hospitals provide recommended care for specific conditions. The AHA recognizes hospitals that follow the latest standards of care laid out in its Get With The Guidelines-Heart Failure program. “Many hospitals and medical centers now have dedicated heart failure disease-management clinics staffed by physicians and nurse practitioners with specialized training and interest in patients with heart failure,” Starling says. “Some cardiologist have additional fellowship training and become board certified in heart failure.” He recommends the Heart Failure Society of America as another resource to learn more about picking qualified health providers.
— As goes for prevention, so goes for proper treatment. To prevent heart failure in the first place, patients are encouraged to adopt heart-healthy behaviors: Eat a low-sodium diet known to be good for the ticker (the Mediterranean diet or DASH diet, for example); don’t smoke; exercise regularly; and get other heart conditions treated ASAP, including high blood pressure. Particularly, Fonarow says, research now shows that keeping the top blood pressure number at or below 120 — not just below 140 — can significantly reduce the risk of developing heart failure. “In addition, there are some new medications for diabetes that may substantially lower heart failure risk,” he says, emphasizing the importance of also maintaining a healthy weight to avoid the condition. And if you’ve already been diagnosed with heart failure, it’s not too late to make these heart-healthy lifestyle changes.” Patients with heart failure should follow the healthy habits that prevent heart failure,” Filippatos says.
— Stick with the program. Experts emphasize the importance of patients following their doctors’ orders — today and tomorrow. That goes for everything from taking prescribed medication to eating a recommended diet. “Heart failure is usually a lifelong condition requiring lifelong treatment and supervision,” Clark says. “However, for very many patients, leading a long and productive life in a state akin to remission from cancer is a common outcome. What matters is getting to see the right specialist team with the right expertise. Even with a diagnosis of heart failure, it is not too late to stop smoking, live healthily and … exercise [regularly] — all things that will improve quality of life and increase survival.”
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Heart Failure: a Growing Problem Worldwide originally appeared on usnews.com
