Does the term “heart failure” put the heart crossways in you? Would the term “heart inefficiency” explain it better and be less frightening? “Because people are unfamiliar with what the term means they get very frightened when they hear it,” says Norma Caples, advanced nurse practitioner in heart failure at University Hospital Waterford.
“Even people who have had heart attacks are actually more frightened of the term ‘heart failure’. They think ‘that’s it, my whole heart must be failing now.’”
The term was generated about 90 years ago and has gone worldwide and is hard to change, she says.
“Some hospitals call it ‘heart efficiency’ but it is still generally known as heart failure. The key message, though, is that treatment for heart failure has become superb in the past 10 years and the majority of people who have it can live well on the medications available and with the education about the condition that they are given.”
So what does it mean exactly?
“It doesn’t mean that the [whole] heart is failing. It means that the heart pump function fails to work efficiently at times, which leads to a build-up of fluid in the body. People of any age can be affected although it happens predominantly in those who are older.”
So what causes heart failure or “heart inefficiency?” There is a long list.
“The most common reason is coronary artery disease or if people had a heart attack. Heart valve disease and uncontrolled high blood pressure can also cause heart failure.”
Interestingly, she adds, diabetes can actually cause heart failure and heart failure can cause diabetes. Heart rhythm problems like atrial fibrillation and certain chemotherapies can cause it too, as can viral infection, smoking, obesity and pregnancy. A high intake of alcohol is responsible for many cases too.
“High intake of alcohol accounts for 40% of our dilated cardiomyopathies - an aspect of heart failure. That’s when there is disease of the muscle of the heart wall so that the shape, size and thickness of the heart has become abnormal. This makes it harder for the heart to pump blood to the rest of the body.”
Blood pressure control
Controlling blood pressure is also vitally important in preventing heart failure, she says.
“50% of our cases would be reduced if blood pressure alone was properly controlled. In relation to that, salt intake in Ireland is very high – twice what is recommended. High salt intake raises blood pressure.
We need to become aware of our salt intake, learn to read food labels and cut down on processed foods. 75% of the salt we consume is hidden in these foods. This high salt content is adding to high blood pressure risk, which is then becoming a risk for heart failure. High blood pressure also increases your risk of developing heart disease, stroke, kidney disease, stomach cancer and even bone loss so it’s something to be very aware of.”
What the GP will do
After telling your GP of your symptoms, he/she will consider your risk factors and do a bnp or nt pro bnp blood test. These bio-marker levels go up in your blood when the heart cannot pump the way it should. If they are elevated, it is a sign that there is stress on the heart wall. This would indicate the need for further tests such as an echo (echocardiogram - an ultrasound of your heart). This looks at the pump functioning of your heart. Your GP would also do an ecg (electrocardiogram) - a simple test used to check your heart’s rhythm and electrical activity.
This would more than likely be abnormal in the presence of heart failure. In relation to high blood pressure, Norma Caples, who runs clinics for heart failure in Dungarvan for UHW, says that while many people are on blood pressure medication, this may not mean that their blood pressure is adequately controlled.
“What I find is that people might be on these [tablets] but are not getting their blood pressure checked often enough so the medication might not be controlling it enough.
“If high blood pressure isn’t controlled it would put you into a risk factor of developing heart failure. Don’t assume that it’s controlled just because you are on medication is the message. Your prescription might need to be adjusted.”
Early diagnosis and early treatment of heart failure is vital for a good outcome. Don’t let your symptoms deteriorate to the point where you need hospitalisation. While heart failure is more common in people over 75, 2% of the population between the ages of 45-75 develop heart failure also.
A 2015 report showed that 90,000 people were living in Ireland with heart failure, but as our population has increased that figure should be closer to 100,000 now and over 200,000 have impending heart failure.
“These are groups, therefore, where risk factors need to be looked at. While heart failure sometimes can’t always be prevented, in some cases it can be prevented by reducing down your risk – reducing salt intake, controlling blood pressure, diabetes and weight. These are all huge things to do to prevent developing heart failure.
“If you do develop it remember that there is excellent treatment available for it now so you can live well with heart failure. In the last 10 years, treatment for it has become superb.”
Engage in education
Learning about how to help prevent your heart failure getting any worse is also important.
“Engaging in education about self-care when you have heart failure is also very important. This is available in the specialist clinics so if you have been diagnosed with heart failure, you should ask for a referral to a heart failure clinic so that they can get the education on heart failure, which is as vital as the medication.”
There are several classifications of heart failure - reduced, mildly reduced, preserved and recovered. The classifications are made depending on how much of the blood is pumped forward every time the heart beats (your heart’s pump function). Medications prescribed depend on what this percentage is.
How medication works
When the heart is pumping abnormally, different hormones are produced in the body. These cause extra stress on the heart and makes the pump function reduce down more. The medication prescribed works to block those pathways from these hormones being produced. That then takes the stress off the heart and allows the heart to pump more efficiently.
Sometimes the aim is to halt the deterioration of the pump function but in many people the pump function may improve also with this medication. If the pump function isn’t as adequate as expected a device implant might be considered, either a defibrillator or a device to help your heart to pump more efficiently.
Note: The medications for heart failure take three to six months to have full effect. A review takes place then with another echocardiogram being done to see how pump function is, how symptoms are and how your blood level is. Those who don’t respond to medication or a device implant are referred on to the Advanced Heart Failure Clinic in the Mater Hospital in Dublin for review and for further treatment such as transplant, if necessary, but this ?happens in very few cases.
Norma finds this figure (alcohol causing 40% of dilated cardiomyopathies) frightening.
“That’s people who drink three standard drinks a day for greater than five years. What I’ve noticed with the COVID pandemic is that the prevalence of people drinking at home has gone really high.”
“Home drinking has become acceptable after the habit was set up during lockdown. This spans all age groups, even people in their 80s and 90s increased their alcohol intake not realising what the [health] risk of it was. It’s important to get that message out there.”
Many people may not realise that they are at risk of developing heart failure, she says, so the most important thing is knowing what the symptoms of heart failure are and seeing your GP if you have them.
“The amount of people [with heart failure] that I have heard saying that they thought they were slowing down, that it was age, but it wasn’t age at all so don’t assume that it is. People, as they get older, become more accepting of symptoms and they might think that it’s just a part of ageing but it might be heart failure that they have.”