Heart failure is the gradual weakening of heart muscle due to which the heart’s pumping capacity cannot meet the body’s requirements. People often believe that after being diagnosed with heart failure, their life can never resume normalcy, or they would die quickly. “In patients with Heart failure, the survival and quality of life can be significantly improved by early diagnosis, strict adherence to gradually up-titrated medical therapy, and supervized exercise regime”, said Dr Nitin Burkule director, Dept of Cardiology, Jupiter Hospital.
To educate people about heart failure, its symptoms, its medical and surgical management options, esteemed doctors from Jupiter Hospital, Thane joined hands with The Times of India initiative “Beat Heart Failure” in partnership with Novartis. The discussion was aimed at instilling hope in patients, emphasizing a life-changing behavior pattern and the treatment options available for most cases.
Dr Burkule took the lead and talked about the primary symptoms of heart failure as shortness of breath in day-to-day activities, fatigue, or dizziness. People cannot do their daily chores, which they could do earlier without discomfort. This happens because the heart cannot cope with the body’s requirements. Other symptoms include swelling in the legs, abdomen, or suffocative feeling at night while lying down, and the person wakes up in the middle of the night gasping for breath.
Dr Shah remarked that heart failure, like fever, is a general term. There can be multiple causes of fever, such as malaria, dengue, typhoid, etc. Similarly, there can be numerous causes of heart failure. The progression of heart failure depends on the underlying cause. If the underlying cause is fast, then the development of heart failure will be quick (such as allergic reactions, infections, blood clots in the lungs, etc.). If the underlying cause is slow (such as Coronary Artery disease, diabetes, hypertension and more), then the development of heart failure will also be slow. Management of fast-developing heart failure requires immediate intervention, and it can be done only in places where trained staff is available.
Many patients confuse heart failure with a heart attack, said Dr Rege. He further explained that a heart attack is the sudden stoppage of the heart’s blood supply. Heart failure is not only the inability of the heart muscle to contract (known as systolic heart failure), but the heart muscle cannot also relax (known as diastolic heart failure). The recent heart failure definition suggests that it is essentially the increase in the pressures within the heart causing an inadequate supply of blood to the body.
While describing the management of heart failure Dr Shah advised to include diet, drugs, and exercise programs. Diet includes avoiding packaged foods. The medications include starting from a minimal dose and gradually increasing it to the optimal amount. An exercise program makes sure it suits the patient. These three steps require many meetings with the patient, and it is possible only with heart failure clinics. These heart failure clinics have trained and skilled staff who communicate with patients, giving the best results. Constant communication has helped more than 20% of patients, gradually reaching up to 50%. Heart failure clinics are equipped to deal with every stage, and they can evaluate the prognosis and the long-term outcome of the patient. A trained counselor guides the patient and his family to deal with the diagnosis.
Dr Burkule emphasized the importance of early detection, saying that it makes a huge difference when diagnosed at the inception compared to ascertaining at a late stage. Unfortunately, due to a lack of awareness among the masses, it is diagnosed late in most cases. The early diagnosis makes it easier to deal with the underlying causes associated with the natural history of the disease and in starting the medication. The medicines given to the patient are not only for the longevity of life but also to decrease hospital admission. Repeated hospitalizations drain the finances. We should not reach a stage where a patient requires hospitalization. Management of the disease is positive assistance to decelerate heart failure progression, improve productivity, and reduce resource consumption.
Dr Shah added to the discussion that the patient’s diagnosis establishes the stage of his heart failure and commencing treatment based on four significant pillars – beta-blockers, ACE inhibitors, ARBs, and Mineralocorticoid receptor antagonists. These are given to every patient with heart failure with reduced ejection fraction or systolic heart failure. In cases with diastolic heart failure because of poor relaxation of the heart, the same drugs are given but managing the underlying cause like diabetes, obesity is also essential. Medicines are started in a small dose and gradually increased to the optimal dose. Some amount of medication is required even after getting better.
He further said that his experience suggests that the drugs are highly effective in improving the heart’s pumping power. Generally, it is seen that only one-third of patients will come back to normal, one-third may deteriorate, and one-third of patients will neither improve nor deteriorate. Still, their quality of life would improve dramatically with Cardiac Rehabilitation. Treatment helps minimize or remove the fatigue and breathlessness seen in patients while performing their daily activities.
Dr Rege explained the four stages of heart failure. In the first stage, the patient is asymptomatic but at high risk of developing heart disease. Mild limitation of physical activity in the second stage. Marked limitation of physical activity in the third stage. In the fourth stage, symptoms present at rest. Heart failure is advanced in the fourth stage. Identifying and detecting the disease in early stages – stage one or stage two is the golden time for beginning the treatment. He said patients must be in touch with their cardiologist after initial treatment and improvement as medication to be continued for whole life in cases of heart failure.
Improving the quality of life is the main objective of the medication and, most importantly, decreasing repeated hospitalization. In cardiac rehabilitation, the patient is imparted many ways of physical training, including simple exercises and muscle training to make him self-sufficient. The person can perform his day-to-day activities by himself and walk some distance without any symptoms. Patients and their families are educated on being physically active with moderate exercise, proper diet, timely taking prescribed medicines, watching body weight, and reducing water intake, including tea, coffee, to monitor fluid building in the body.
Treatment options are available
In most cases barring a few to help patients recover and improve their quality of life. Patients with advanced heart failure are a challenge, but there is still hope. Advanced heart failure treatment includes surgical options – heart transplant and left ventricular assist device. Heart transplants are recommended in those patients who are not suffering from any other organ end-stage disease. A heart transplant improves the quality of life to almost normalcy. The patient is required to take immunosuppressive drugs throughout their life. Nationwide organ sharing is essential to support the advances in transplant therapy.
If a person has any unusual symptom, they should immediately seek advice from their primary care physician. If diagnosed with heart failure, they should not lose hope as management and medication of every stage of heart failure is available. Many new medicines are available that have shown tremendous results. Heart failure is not the end of life but an opportunity to start living healthy.