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Protect yourself from heart failure.

More than 5.1 million Americans currently live with heart failure (HF), according to the American Heart Association (AHA). A recent AHA policy statement (Circulation: Heart Failure, online April 24) predicts that number will increase to 8 million by 2030, and that the cost of treating HF could more than double to $70 billion by 2030.

The projected costs for adults age 65 to 79 increased the most: from $11.50 billion to $29.9 billion. "This reflects the fact that the U.S. population's average age is increasing, and older people tend to be at higher risk for HE" says Mount Sinai cardiologist Bruce Darrow, MD. Another factor is that more people are surviving heart attacks and living with damaged hearts--about 28 percent of men and 41 percent of women who survive a heart attack develop heart failure within five years.

However, while most patients are diagnosed after age 65, HF is not an inevitable part of aging--and despite its name, HF isn't always hopeless. "Existing treatment guidelines can help to lessen its burden," Dr. Darrow emphasizes.

Systolic or diastolic? Which type of HF you have (not analyzed in the AHA study) is a factor in how the condition may affect you. There are two forms--systolic and diastolic--both of which affect the heart's lower chambers (ventricles). The difference is based on ejection fraction (EF), which is the amount of blood the heart pumps out with each contraction. A normal EF is 55 to 65 percent.

* Systolic HF is more common in men. It occurs when the left ventricle becomes large and contracts so weakly that it can't expel blood efficiently to the body. People with this type of HF have ejection fractions of 10 to 40 percent, and it can carry a poor prognosis.

* Diastolic HF In diastolic HF, pumping strength is preserved and the EF is normal. However, the ventricles don't relax properly, which means they can't fill properly with blood. This form of HF is more common in women, and is not as deadly as systolic.

What you can do to avoid HF Doctors are increasingly becoming aware of the fact that in some cases, HF may be preventable or at least controllable. This is because HF often is the result of another disease or condition--for example, high blood pressure, prior heart attacks, irregular heart rhythms, and/or cardiomyopathies (diseases of the heart muscle). Diabetes and kidney disease also can underpin HF, while other causes include certain medications--for example, some chemotherapy drugs--and radiotherapy to the chest area for the treatment of breast cancer.

You can protect yourself from HF by being proactive when it comes to managing your risk factors. "Controlling your blood pressure is stone number one," says Dr. Darrow. "It affects about 75 percent of HF patients, and can go undiagnosed for years." If you have high blood pressure, follow your doctor's advice when it comes to taking medication to control the condition. "People often stop taking their meds because they feel well," Dr. Darrow observes, "but high blood pressure typically causes no symptoms even while it is damaging the heart."

Keeping your blood sugar, cholesterol, and weight at healthy levels also is vital. Along with your blood pressure, these risk factors can be mitigated via a healthy diet that is high in fruits and vegetables, whole grains, and healthy fats (found in nuts and fatty fish) and low in refined (white) grains and red meat. "Physical activity also is important," Dr. Darrow adds. "Aim for 30 minutes' brisk walking each day. Also quit smoking, and get adequate sleep."

If you already have HF Even if you have been diagnosed with HF, you can do much to preserve and even improve your health. Important steps include making many of the same lifestyle modifications that reduce the risk for HF. Rest is important, but so is exercise--in fact, while you may think the opposite is true, exercise can reduce HF symptoms. "Studies have shown that HF patients who take the most exercise are less likely to be hospitalized, and fewer die from heart-related causes," Dr. Darrow confirms. "However, take the precaution of consulting your cardiologist about any exercise program you engage in--he or she may recommend a formal cardiac rehabilitation program."

HF sufferers also should consume a healthy diet, taking particular care over the amount of salt and fluids they consume, since both may result in high blood volume, which forces the heart to work harder than it should. Your doctor will advise you on how much salt you can safely consume--the AHA recommends a maximum of 2 grams per day for those with HF. Your doctor also may recommend a daily fluid allowance--be sure to factor in liquid-based foods, such as soup.

Medical treatments Improvements in medication and device therapies also are helping to make HF a more manageable condition. "Drugs can help to lower blood pressure, stabilize the heart rate, and improve the heart's pumping ability," says Dr. Darrow. Some patients may benefit from an implantable cardioverter defibrillator (ICD), a device that administers an electric shock if needed, to help the heart beat at a normal rhythm. Other key devices in the treatment of HF include bi-ventricular pacemakers."

Life expectancy is improving for HF patients, but there is no way to predict survival. That said, about one-third of HF patients return to normal function with optimal medical therapy, and another third can improve their strength and quality of life through medication and lifestyle changes. "Compliance with medications and your doctor's recommendations makes a huge difference," Dr. Darrow concludes.


* HF occurs when the heart is unable to pump sufficient blood to other parts of the body. As the heart struggles to pump, it may enlarge, but it gets weaker and fluid can build up around the muscle.

* Common signs of HF include fatigue and breathlessness, even when at rest. Other symptoms may include coughing and/or wheezing, swelling of the ankles, feet, legs and/or abdomen, weight gain due to fluid building up in the body, dizziness and confusion, and an increased heart rate.

* Managing other cardiovascular conditions, such as diabetes and hypertension, will greatly improve your odds of living well with HF.
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Publication:Focus on Healthy Aging
Date:Aug 1, 2013
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