Heart failure is a commonly rising medical problem these days, especially in the elderly population. The prevalence of heart failure ranges from 1.3-4.5 million with an annual incidence of 0.5-1.8 million people worldwide. More than 65 years of age contribute about 10-15% of heart failure patients in the general population. The mortality is about 30% in 1st one year and as high up to 50% in the next 5 years even with treatment. The common causes of heart failure are ischemic heart disease (blockage of arteries), rheumatic heart disease (valvular disease), uncontrolled blood pressure, thyroid abnormality, and cardiomyopathies (heart muscle disease).
Heart failure is a complex syndrome where the heart is not capable of meeting the nutritional or oxygen requirement of the body due to its structural or functional abnormality.
Manifestation/symptoms of Heart Failure:
The most common symptom of heart failure is shortness of breath on exertion or at rest or sometimes while sleeping. Heart failure patients often present themselves with swelling of both feet, abdominal distension due to fluid overload in the body. Generalized weakness and fatigue with exercise intolerance are also common symptoms. Sometimes, coughing during the night time could be an indicator of incipient heart failure.
How Indian heart failure patients are different?
Heart failure in the Indian community presents about a decade earlier, more commonly with low pumping of the heart and with the worse outcome on treatment in comparison to the western population.
Tests useful in the evaluation of heart failure:
ECG could show abnormal heart rhythm, ECHO cardiography delineates the structure and function of the heart, Chest X-ray helps in detecting enlarged heart or fluid in the lungs.
Blood tests like thyroid profile, BNP/NT-Pro BNP differentiates between breathlessness due to heart failure from other causes.
Coronary Angiography or Cardiac MRI could be needed in selected patients.
Treatment modality for heart failure patients:
Lifestyle modification – restriction of salt & fluid as advised by the doctor. Regular exercise training to maintain physical endurance. Weight reduction for overweight and obese patients. Control of blood pressure, blood sugar, and cholesterol.
The available medications for heart failure are ACE inhibitors, beta-blockers, diuretics, digoxin, newer drug valsartan/secubitril combination, and aldosterone antagonist have shown promising role over decades in prolonging the life of heart failure patients.
Devices helpful in heart failure patients:
Automated Intracardiac Defibrillator (AICD). Biventricular Pacing Device (CRT-D/P). Mechanical heart (left ventricular assisted device).
Role of heart transplantation in heart failure:
Patients who are in refractory heart failure even on the best of medicines are the candidates for heart transplantation. Heart transplantation has grown well in the past one to two-decade with good results but of course with limitation of the donor heart and life long immuno-suppressive medications.
Observing the increasing trend of heart failure patients in the community needs early identification and treatment so that morbidity, mortality, and financial burden over the family and country health system could be put on check.
AWARENESS REGARDING HEART FAILURE SYMPTOMS, EVALUATION, AND TREATMENT IS THE KEY TO COMBAT THIS DREADFUL DISEASE TO IMPROVE QUALITY OF LIFE AND PROLONGING LIFE IN ELDERLY PATIENTS.
Dr. Rajni Sharma, Senior Consultant – Cardiology, Narayana Superspecialty Hospital Gurugram