People are now living longer with their ischaemic heart disease and they’re surviving their initial heart attack but then go on to suffer consequences such as heart failure.
With the aging population and the increase in cardiovascular risk factors, it is being recognised as an epidemic of the 21st century. We estimate up to 50 per cent of those with heart failure don’t even know they’ve got it. Commonly affecting men at an earlier age, heart failure is a condition where the heart’s unable to pump, as efficiently as it should, so it may be enlarged and weak, so it can’t pump the blood out to the body.
Or the heart can be thick and stiff, so it can’t fill with blood, resulting in build-up of fluid in the legs or the lungs – this is the type more frequently experienced by women. It presents most commonly with breathlessness or swelling in the legs, but may be as simple as just feeling fatigued or having an inability to do what a person used to be able to do. It can impair things like cognition as well, and it’s strongly associated with depression. It’s also more common in patients with hypertension, diabetes, obesity, and more recently, a lot of evidence coming along, from toxins such as chemotherapeutic agents, as well as illicit substances within the community.
Management of heart failure differs based on the patients’ diagnosis. For those with weakened hearts we use a range of four or five different tablets and even pacemakers and defibrillators, devices that can improve survival. In patients with stiffened hearts we’re really just managing the background risk factors. These are blood pressure, diabetes, exercise levels and managing the fluid that they build up (such as using diuretics).
For minimising the chance of developing heart disease, the focus really needs to be on prevention in primary care. This means your annual health check at the GP is a very important opportunity to pick up those risk factors, including things like atrial fibrillation, irregular rhythms, as well as vital monitoring for the progression of high blood pressure, diabetes and obesity.
Heart failure is one of the more preventable diseases that we have, yet it’s potentially one of the most common causes of mortality.
Lifestyle changes are the first place to start. It’s important that patients with heart failure should be encouraged to exercise; just as important as in every other disease condition. This of course needs to be adjusted to the person’s clinical status. So it’s always good to get advice as to an exercise program that might be appropriate from a doctor or relevant health professional.
Ensuring you consume an appropriate diet is also important. In general, this should be the same diet that we promote for coronary artery disease – patients should eat a healthy diet of fresh produce, vegetables, fruits, nuts, fish, seed-based products and avoid highly processed foods.
A reduced salt diet is a key part, because high consumption of salt leads to fluid retention in the body. The fluid then deposits in the lungs and legs, leading to heart failure and other exacerbations.
Talking to your GP could mean a significant reduction in heart failure in the future.