En español | A study published this month in JAMA Cardiology confirms that deaths from heart disease have increased; this study found they rose 8.5 percent from 2011 to 2017 after years of steadily decreasing. But the picture is even darker where heart failure in particular is concerned: Mortalities increased a whopping 38 percent in the same time period — with most occurring in people age 65 and older.
Part of the explanation for the heart failure numbers, experts say, is rising rates of obesity and diabetes. A rapidly aging population that received better treatment for other types of cardiovascular disease earlier on is another piece of the puzzle. “We've gotten good at taking care of other forms of heart diseases, so folks are living longer and, with that, the progression of heart disease becomes heart failure more often,” says Brian Lima, a cardiothoracic surgeon and director of heart transplantation surgery at Northwell Health in Manhasset, New York. In other words, many older adults survive a heart attack or stroke in middle age only to face years of chronic, life-threatening heart failure later on.
Heart failure doesn't mean the heart is no longer working at all. Rather, it occurs when the heart is unable to pump an adequate supply of blood to the rest of the body. Without the needed supply of nutrients and oxygen that blood brings, cells all over the body suffer, leading to symptoms such as these:
- Fatigue, or feeling tired all the time during everyday activities such as walking or shopping
- Buildup of fluid in the body, including swelling in the feet, ankles, legs or abdomen, or weight gain
- Dizzy spells
- Persistent coughing or wheezing
- Lack of appetite; either feeling full or being sick to your stomach
- Confusion and impaired thinking; feeling disoriented or experiencing memory loss
- Increased heart rate or heart palpitations that feel like your heart is racing or throbbing
Thanks in part to new medications like Lasix, a diuretic that rids the body of excess fluid, and Enestro, which uses the body's hormone system to regulate blood pressure — plus technological advancements for opening blocked heart arteries that once were unfixable — 6 million American are today living with heart failure. By 2030, it's estimated that nearly 8 million Americans will be. Of those, 2 million will be 80 or older. According to the American Heart Association, of all adults 40 and older, 1 in 5 will develop heart failure in their lifetime.
What you can do
In addition to medication, lifestyle changes can increase your quality of life if you have heart failure. Among other changes, the American Heart Association recommends these:
- Quit smoking. Nicotine temporarily increases heart rate and blood pressure, decreases the amount of oxygen circulating in the body and leads to stickiness of the blood vessels that feed the heart — all big negatives for those with heart failure.
- Weigh yourself every day at the same time. Sudden weight loss or gain may indicate that your heart failure is progressing.
- Lose excess weight. Carrying extra pounds forces your heart to work harder.
- Eat a heart-healthy diet of fruits, vegetables, whole grains, low-fat dairy products, skinless fish and poultry, legumes and nuts. Limit salt; it contributes to unwanted water retention. And avoid trans and saturated fats that can cause your heart to have to work harder.
- Monitor your blood pressure at home and report any changes to your doctor. Hypertension, plus obesity and diabetes, helped drive a 51 percent increase in the number of heart-failure deaths in adults under age 65 between 2011 and 2017, the JAMA Cardiology study showed. Many adults with heart failure will need to take several blood pressure drugs to keep hypertension under control.
- Improve your sleep at night to keep your heart at its healthiest. Avoid long naps during the day and big meals before bed.
- Know that flu and pneumonia are dangerous for people with heart failure, and talk to your doctor about getting vaccinations to ward them off.
For some, staving off the condition could be as simple as seeing their primary care physician for the standard heart, cholesterol and blood pressure checks that could lead to preventive treatment. Diabetes drugs called SGLT-2 (sodium-glucose co-transporter 2) inhibitors, for instance, have also been shown in recent research to lower the risk of heart failure.
If your doctor thinks you already have signs of heart failure, he or she can arrange for an ultrasound that will indicate whether your heart is weak or dilated. A simple chest X-ray may reveal fluid congestion of the lungs and an enlarged heart, all indicators of possible heart failure.
From there, Lima says that swifter referrals to cardiologists are in order, noting that a greater sense of urgency should be given to a disease with a similar five-year survival rate as lung cancer. “Heart failure patients are not referred to specialists early enough, and by the time we see them, they are really in trouble."
The standard protocol for treating heart failure, says Lima, is titrating medications to find the maximally tolerated dose that won't cause problems such as low blood pressure or kidney damage. Unfortunately, most patients eventually progress to advanced heart failure, where medications alone are inadequate and the patient needs some form of “heart replacement therapy.”
Historically, the best option in these instances has been a heart transplant. But for the thousands of patients who progress to advanced heart failure, there's a limited supply of donor organs available for transplant. The next best option is a mechanical substitute for the heart, namely a left ventricular assist device (LVAD) that is surgically implanted.
Both treatment options for advanced heart failure can yield excellent outcomes, so long as patients are not seen too late in their disease course, says Lima. Transplants may be restricted to those in their 70s or younger, but LVAD is still a viable option well into a patient's 80s. The key, Lima says, is being evaluated for such options soon enough, before other organ systems begin to close down. “It's never too early to be evaluated for advanced heart failure treatment options, but it can definitely be too late.”