Getting a Handle on Heart Failure

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Heart failure—also known as congestive heart failure—occurs when your heart can’t pump enough blood with adequate force to meet the body’s needs. It’s a common condition, affecting about 6.5 million people in the United States, according to the Centers for Disease Control and Prevention (CDC). Signs of heart failure include shortness of breath, fatigue, and fluid buildup and swelling in the legs, ankles, and feet.

Although heart failure is a largely preventable condition, a new study has found that the number of deaths from heart failure in people ages 65 and older went up significantly in the United States between 2011 and 2017. The study, published in the December 2019 issue of JAMA Cardiology, analyzed data from the CDC.

During the study period, the population of people in the 65-and-up age group grew nearly 23 percent and the number of overall heart disease deaths increased by about 8.5 percent. But a larger senior population doesn’t fully account for the higher numbers of heart failure deaths. When the researchers looked at the percentage of deaths from heart-related conditions in people 65 and older—a statistic known as the age-adjusted mortality rate—they found that death rates for overall heart conditions went down from 2011 to 2017, falling 5 percent for heart disease and 15 percent for coronary heart disease. But the death rate went up nearly 21 percent for heart failure.

Possible causes
Although the study didn’t look at reasons for the increase in heart failure death rates, the researchers said that possible causes include the substantial increases in rates of obesity and diabetes that began in the mid-1980s and have skyrocketed since then.

Being obese can contribute to heart failure because it requires your heart to work much harder than it would have to if you weren’t obese. And diabetes can significantly raise your risk of various heart conditions, including heart failure. According to the American Heart Association, adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes. In addition, people with diabetes are likely to develop high blood pressure and atherosclerosis (narrowing of the arteries), both of which can contribute to the development of heart failure.

Managing heart failure
Although there’s no cure for heart failure, it can be managed in a way that can help prevent it from getting worse. Although life expectancy after a heart failure diagnosis varies, medical treatment and lifestyle changes can reduce heart failure symptoms and may extend the length of your life. Some treatments to manage heart failure include:

Lifestyle changes. Choices you make every day, such as the following, can help manage heart failure symptoms:

  • Quitting smoking
  • Avoiding alcohol
  • Avoiding respiratory infections such as the flu and pneumonia by washing your hands, avoiding people who are sick, and getting flu and pneumonia vaccines
  • Controlling blood sugar if you have diabetes
  • Cutting back on salt to no more than 1,500 mg of sodium a day
  • Eating a healthy diet (such as the low-sodium Dietary Approaches to Stop Hypertension, or DASH, diet) that includes fruits, vegetables, whole grains, lean protein, low-fat dairy, legumes, nuts, seeds, and nontropical vegetable oils, while avoiding red meat, processed meats, sweets, sugary beverages, and foods with saturated fat, trans fat, or cholesterol
  • Exercising if your doctor recommends it
  • Following your doctor’s recommendation about sexual activity
  • Getting enough sleep at night
  • Limiting your fluid intake as per your doctor’s instructions (not everyone needs to decrease their intake)
  • Losing weight if you’re overweight or obese

Medication. Doctors use various types of medicines to treat heart failure, depending on the type of heart failure you have, and whether you have underlying conditions related to your heart failure, such as high blood pressure. Some medicines used for heart failure include:

  • Angiotensin-converting enzyme (ACE) inhibitors to lower your blood pressure
  • Beta-blockers to slow your heart rate
  • Aldosterone receptor antagonists to assist your body in eliminating excess sodium and lowering blood volume
  • Digoxin (Lanoxin) to help strengthen your heartbeat so your heart can pump greater amounts of blood
  • Diuretics that help control fluid buildup and swelling

Regular checkups. Exams, blood tests, and imaging tests can tell your doctor how well your heart failure treatments are working and whether you need changes in your medication. To optimize your care, be sure to keep all your medical appointments and schedule testing as needed. And tell your doctor if you notice new symptoms or changes such as increased shortness of breath, more swelling in your legs or abdomen, sudden weight gain, or a sudden dry cough.

Medical procedures and surgery. Implanted medical devices may help certain types of heart failure symptoms. For example, a cardiac resynchronization therapy device (a type of pacemaker) can help coordinate the contraction of the four chambers of the heart. Heart failure patients may also benefit from treatments such as an implantable cardioverter-defibrillator device, a left ventricular assist device (a mechanical heart pump), or a heart transplant.

Struggling with self-care
Self-care strategies can prevent heart failure from worsening, but research has found that many people don’t implement these strategies. Why? Physical and mental limitations and a lack of information seem to interfere with self-care, according to a study published in the European Journal of Heart Failure in November 2019. The study found that most elderly patients admitted to the hospital for heart failure are unable to perform essential tasks needed for heart failure self-care.

The study followed 415 patients (average age, 80) hospitalized in Spain for heart failure. It looked at the patients’ ability to perform six essential tasks required for self-care, including weighing themselves on a scale and then recording their weight, identifying their diuretics and knowing when their doses might need to be adjusted, recognizing swelling in their ankles, and identifying salty foods they should avoid.

The study found that on average, patients could perform fewer than three of the six tasks, and only 22 of the 415 patients were able to perform all six of the tasks correctly. Poorer self-care ability was associated with older age, female gender, lower education level, lower health literacy, higher rate of depressive symptoms, a higher level of frailty, and lower scores on the Mini-Mental State Examination of cognitive impairment, although people with cognitive decline were excluded from the study.

Only one-third of patients could identify whether they had swollen ankles, an important sign of worsening heart failure. And even among patients who believed they could identify and avoid high-salt foods, less than half were able to recognize salted food.

Self-care findings matter, because the study found that patients with low self-care proficiency were more likely to die during the year after hospitalization than those with high self-care proficiency. Of the 415 patients in the study, 88 died. That included 33 percent of the low-proficiency self-care group, 21 percent of the moderate-proficiency self-care group, and 14 percent of the high-proficiency self-care group.

The researchers discovered that people in the high-proficiency self-care group were more likely than the other groups to see a primary care doctor for follow-up during the first month after hospital discharge and to have help dealing with their condition. A limitation of the study was that it was done at a single center, so outcomes could differ in other settings. There was also no control group to measure outcomes against.

If you have heart failure, two lessons you can take from this study are to educate yourself about your condition and tell your doctor if you notice any changes in how you feel. You can also avoid triggers such as salty foods that can cause your symptoms to flare up and seek help from family members or professional caregivers who can assist you in your self-care regimen. Doing so could extend your life, especially after a hospital admission.