Cardiologists have referred to heart failure as a “global pandemic” - it’s one that affects approximately 26 million people worldwide, and though there have been incredible advances in cardiac care over the last few decades, the number of cases continues to climb. We will take a look at what’s to blame for this increase as well as what you can do to help decrease the odds that you will suffer from heart failure.
What is heart failure and what causes it?
Heart failure is a complex syndrome which affects the pumping action of the heart muscle and results in an inability to maintain proper blood flow throughout your body. The World Heart Federation points to 4 main causes of heart failure:
“The very commonly quoted statistic is that for US adults aged 40, the subsequent lifetime risk of developing heart failure is 1 in 5,” said Dr. Amanda Vest, Director of Tufts Medical Center’s Cardiac Transplantation Program. “There are also conditions which put people at particular risk including hypertension, diabetes and obesity, or having a genetic variant that is associated with cardiomyopathy in family members.”
Lifestyle features such as consuming too much salt, smoking, abusing alcohol and drugs can increase your risk of heart failure, as does failing to adhere to prescription medications you may have been prescribed to help ward off heart failure.
Why are the numbers rising?
“There are two things I believe are behind the rising numbers of patients with heart failure,” said Dr. James Udelson Chief of Cardiology at Tufts Medical Center. “The aging population is definitely one reason. The other is that more people are surviving heart attacks and myocardial infraction episodes today than ever before. Years later they become heart failure patients. It’s simply a side effect of better medicine.” Dr. Udelson adds that aging alone doesn’t mean you are destined to suffer from heart failure, but the likelihood does increase as we age. However, there’s another issue that can be harder to pinpoint. “The dissemination of drugs and devices aggressively treating patients in the community is suboptimal,” said Dr. Udelson. “When you look at cardiology practices or hospitals and survey thousands of patients, you find the percentage of people on the right drugs, or the right doses of the right drugs, is much lower than it should be.”
He adds that cardiac care is quite complex and treating heart failure involves managing at least 4 different medications and steadily increasing the dose over several weeks.
“Ideally it takes an organized disease management program to do that, and those don’t necessarily exist everywhere, Dr. Udelson explained. “Which is why seeing a cardiologist as soon as possible is recommended.”
What can you do to prevent heart failure?
The good news is that there are very tangible things we can all do to help prevent heart disease associated with an unhealthy lifestyle. Dr. Vest says we can all aim to maintain a normal-range weight throughout life.
“Five studies have compared adults with severe obesity who had bariatric surgery compared to patients with obesity who did not,” said Dr. Vest. “These studies show that the risk of heart failure development is about halved for the individuals who pursued surgical weight loss, showing that obesity is a modifiable factor and those who lose weight substantially lower their risk. For those with less weight to lose, even 5 or 10 pounds through diet and exercise can significantly improve our cardiac health.”
You can also look at the American Heart Association’s Life’s Simple Seven for other ways to cut your risk. In addition to maintaining a healthy weight, the AHA recommends you stop smoking, eat healthier, exercise, manage your blood pressure, control your cholesterol and reduce blood sugar levels.
New treatments showing great promise
In 2008, there had been concern that some diabetes medications increased your risk of heart attack. This caused the FDA to say that any new diabetes drugs would need to be put through a rigorous cardiovascular outcomes study to make sure the drug isn’t harmful. Doctors were surprised at the results of two of the first diabetes meds to go through this new protocol. Empagliflozin (sold under the brand name Jardiance) and Dapagliflozin (sold under the brand name Farxiga) actually lowered the risk of heart attack and new onset of heart failure in patients with diabetes.
“Massive trials were then conducted using patients who already had heart failure, about half of whom were not diabetic,” said Dr. Udelson, “and they found very favorable effects in reducing progression to worsening heart failure and the risk of death. It’s quite remarkable, even in the non-diabetics. Within the last year or two, both dapagliflozin as will empagliflozin.”
Medications for heart failure can be quite costly, and Dr. Vest says this is another area the team at Tufts Medical Center can make a huge difference in for patients.
“We are fortunate to work in a multidisciplinary team that includes pharmacists and pharmacy technicians who investigate what insurance will pay for,” she said. “Our pharmacy specialists are excellent at seeking out manufacturer coupons to reduce the cost to our patients, or eligibility for co-pay assistance programs which is another way patients can lower costs.”