About five million Americans suffer from heart failure, but this disease can be avoided.
Unfortunately, few patients and doctors are aggressive enough in following through on treatment of the risk factors, such as high blood pressure (hypertension), elevated cholesterol and atherosclerosis (fatty buildup in the arteries), that can lead to heart failure.
What Is Heart Failure?
Any disease that weakens the heart muscle can, over time, result in heart failure. With heart failure, the heart is damaged and becomes unable to supply sufficient amounts of blood to the rest of the body. Common symptoms include fatigue, shortness of breath and swelling in the legs, ankles and feet.
Without adequate treatment, the heart muscle becomes damaged and weakened to the point that it can no longer adequately pump blood throughout the body.
It sounds obvious and it may be inconvenient, but research shows that about 50% to 80% of all cases of heart failure could be prevented with lifestyle modifications and/or better management of the risk factors.
An Undertreated Disease
Over time, the impaired circulation that marks heart failure can cause congestion" of blood in the lower legs, lungs, liver or abdomen often leading to fatigue, weakness and shortness of breath.
When heart failure is inadequately treated, many serious complications can result, including pump failure (when the heart malfunctions and pumps inefficiently)...sudden arrhythmias (abnormal heart rhythms)..kidney failure (due to reduced blood flow)...and heart attack or stroke (from clots triggered by impaired circulation).
There isn't a cure for heart failure. The challenge is to relieve symptoms and restore most of the heart's normal function. When heart failure is severe, pumping devices or even a heart transplant may be considered. Latest findings on treating heart failure…
Most Effective Treatments
In addition to controlling the conditions that often accompany heart failure, patients can reduce heart symptoms with a combination of medications…
- Beta-blockers. They're among the most effective drugs for heart failure because they slow the heart rate, reduce the heart's workload and protect the heart against harmful neurohormones (chemical messengers that overproduce and cause damage in heart failure).
Patients treated with beta-blockers can experience an improvement in ejection fraction (a measure of the heart's squeezing ability of seven to 10 percentage points, which is enough to reduce symptoms, such as fatigue. Their risk of dying from heart failure can be reduced by 30% to 40%.
Two drugs, which are often underdosed, have been shown to be effective.
For best results: Metoprolol (Lopressor) taken at a dose of 200 milligrams (mg) daily...or carvedilol (Coreg) at a dose of 25 mg twice daily.
- Aldosterone antagonists. These drugs, which include spironolactone (Aldactone), are known as potassium-sparing diuretics because they're less likely than older drugs to deplete potassium from the body. Most people with heart failure require diuretics to remove excess fluids from the body since the heart's inefficient pumping action can lead to fluid buildup.
Troubling research: Researchers at the University of California, Los Angeles, published a study showing that only about one-third of patients who should be taking these drugs are getting them. Many doctors are reluctant to prescribe aldosterone antagonists because they require frequent monitoring and dose adjustments to prevent increased levels of potassium.
However, aldosterone antagonists can reverse scarring of the heart and improve its pumping ability. They improve survival by at least 30% and also reduce the risk for sudden death from heart disease.
For best results: A typical starting dose of spironolactone is 125 mg once daily, but your dose may vary depending on your symptoms, renal function and potassium level.
- Angiotensin receptor blockers. These drugs, including losartan (Cozaar), are designed to relax blood vessels so that it's easier for the heart to pump blood.
For best results: The standard dose for losartan used to be 50 mg, but new research indicates that 150 mg can significantly reduce the need for hospitalization due to uncontrolled heart failure symptoms. Side effects include cough, elevated potassium, dizziness and headache.
When More Help Is Needed
If you have made lifestyle changes (such as reducing fat in your diet and getting regular exercise) and have received maximum treatment with medication but still suffer symptoms of heart failure, you may need even more help.
- Cardiac resynchronization is a relatively new treatment in which electrodes are placed on the left and right sides of the heart. Electrical impulses delivered to the electrodes from an implanted biventrical pacemaker paces both sides of the lower chambers of the heart, improving the heart's pumping action. A battery pack that is a little smaller than a deck of cards is implanted under the collarbone.
Evidence that it helps: Cardiac resynchronization, combined with medication, can reduce hospitalizations from heart failure complications by 50%.. and reduce the risk of dying from heart failure by 35% to 40%.
- Left ventricular assist device (LVAD). Former vice president Dick Cheney had surgery for implantation of an LVAD. This device gives a boost to the heart's main pumping chamber and helps it deliver blood to the rest of the body. The LVAD, which is surgically attached to the left ventricle and connected to a power source (such as batteries) outside the body, is an important breakthrough because the majority of patients who receive the implant may survive long enough to get a heart transplant.
One device, the HeartMate II, was approved by the FDA in April 2008. Research found that patients given this device had one-year survival rates of 68% compared with 55% with earlier-generation LVADs.
Additional Useful Therapies
Other therapies that can help ease heart failure symptoms…
- Omega-3 fatty acids. In a study of nearly 7,000 heart failure patients who received either placebos or 1,000 mg of omega-3s daily, those taking omega-3s were about 10% less likely to die.
- Intravenous iron. Heart failure patients who are deficient in iron may improve slightly when they receive iron intravenously. This treatment isn't approved by the FDA for this use, and it hasn't been proven to prolong survival times. However, in those who are iron-deficient (even if they don't have anemia), intravenous iron may help ease symptoms. If you have heart failure, ask your doctor about having your iron levels tested.
- Sodium and fluid restriction. Since a high-sodium diet can significantly increase blood pressure in many people, individuals with heart failure should limit their sodium intake. The optimal sodium intake for heart failure patients hasn't been established, but they are usually advised not to exceed 1,500 mg daily.
Fluid restriction is also important, particularly for those who have congestion. Patients who struggle with fluid retention should limit the amount they drink to about two liters (about 68 ounces) daily.
Caution: Heart failure patients should never take aspirin or any other nonsteroidal anti-inflammatory drug (NSAID) without consulting a doctor. These drugs have been associated with a worsening of heart failure symptoms. Acetaminophen (Tylenol) may be a better option. Certain diabetes drugs, such as rosiglitazone (Avandia) and pioglitazone (Actos), also should be avoided by people with heart failure.
Hysterectomy and Your Heart
Women who have hysterectomies before age 50 are nearly 20% more likely to develop coronary artery disease or heart failure or have strokes than women who have not had hysterectomies.
Possible reason: Removal of the uterus disrupts blood flow to the ovaries, decreasing heart-protective estrogen. No link has been found between hysterectomy and heart disease in women over age 50.