Our heart is the central pump of our circulatory system and responsible for pumping blood to organs of our body, throughout our lives without any break, to ensure smooth functioning. Due to multiple factors, our heart muscles tend to get weak, and our heart is unable to pump blood, as it should be. But heart failure is not heart attack, where there is a sudden stoppage of blood flow to the heart. According to the Trivandrum Heart Failure registry, the first-year mortality rate due to heart failure is thirty percent, in the second-year forty-five percent and sixty percent in the third year, if left untreated.
The mortality rate due to heart failure is a wake-up call for people to live a healthy life and get regular check-ups done from the primary healthcare provider. To create awareness about the disease, its management and treatment options, The Times of India initiated the campaign Beat Heart Failure in partnership with Novartis. Senior doctors from India’s best hospitals have also joined the initiative to disseminate the knowledge about heart failure.
To address the concerns/questions and the critical pillars of the heart failure treatment, eminent doctors from the prestigious Max Hospital, Saket, New Delhi joined the discussion. During the discussion doctors talked about principal components for the management of heart failure and emphasized on timely diagnosis, prognosis, symptoms, medical management, diet, exercise, weight management, productivity in life, work and the need for regular follow ups to stay ahead of heart failure.
The doctors who have participated in the discussion were: – Dr. Balbir Singh: Chairman- Cardiology – Dr. VK Chopra: Senior Director – Cardiac Sciences – Dr. Rajneesh Malhotra: Principal Director – CTVS https://fb.me/e/2cpM70Z8O Heart failure in simple words is the inability of the heart to pump blood sufficiently to the whole body. Heart failure can be divided into two types – Systolic heart failure and Diastolic heart failure, depending on the ejection fraction, explained Dr V K Chopra. Ejection fraction is the amount of blood pumped by the heart.
Systolic Heart failure due to reduced ejection fraction occurs due to weakness of the heart muscles when the heart cannot pump enough blood. It is easily identified by the primary healthcare provider.
In Diastolic heart failure occurrence, heart muscles do not relax, and a decreased amount of blood reaches the heart from lungs causing lung congestion, gradually resulting in heart failure. Diastolic heart failure is not much recognized in India, as it does not get revealed in an ECG test and patients with diastolic heart failure are mistakenly referred to a pulmonologist or to a psychiatrist in the worst-case scenario.
Seventy-five percent of patients in India are diagnosed with systolic heart failure and fifteen to twenty percent with diastolic heart failure or preserved ejection fraction, stated by Dr V K Chopra. However, with increasing awareness and specialized care center, the percentage of patients with diastolic heart failure is now getting diagnosed and their cases are showing increasing trend.
The burden of heart failure in India is eighteen to twenty-two million people, as Southeast Asians genetically are predisposed to cardiac diseases besides other risk factors. The major causes for cardiac diseases include heart attack and heart muscle infection. Hypertension or other risk factors for cardiac disease includes obesity, diabetes and sedentary lifestyle. India is poised to become the diabetic capital of the world, rued Dr Chopra.
Term heart failure is often misinterpreted, and people remark that heart has failed. Medically, we need to understand that heart failure is a progressive disease and often happens at a late stage, averred Dr Singh. The three cardinal symptoms of heart failure include gradually increasing of breathlessness during exertion like walking and climbing stairs, swelling on the feet and inability to lie down straight. Majority of patients attribute these signs to weakness and acidity ignoring other aspects like diabetes and hypertension. These signs indicate beginning of heart failure.The diagnosis heart failure by physician can be done easily by looking at the three parameters i.e., ECG, blood biomarker and the patient’s clinical symptoms.
Dr Chopra insisted on early recognition of the disease. Patients with diabetes, hypertension and family history of cardiovascular diseases should be investigated early and regularly. He added that many Indians having coronary artery disease and heart attack are at least ten years younger as compared to western counterparts. Patients with diabetes are vulnerable to silent heart attack. Their arteries may be alright, but heart muscles might have become weak.
In India, a rise in heart failure cases in the younger population is a great concern and major attributed factors are poor lifestyle, consumption of junk food, smoking, lack of exercise and alcohol. Heart failure is the price paid for choosing an unhealthy way of life. People diagnosed with heart failure must be counseled and explained about the available treatment and self-management tips to improve their life.
Dr Singh while emphasizing on early diagnosis said that low pumping efficiency of the heart can lead to sudden cardiac arrest resulting in instant death. Only one or two patients are able to reach the hospital for timely management.
Dr Singh apprised that the global research project to “improve SCA (Sudden Cardiac Arrest)” highlights three significant risk factors for developing sudden cardiac arrest – one, reduced ejection fraction complication resulting from low pumping efficiency, second, missing ECG beats or a history of syncope (fainting spells) where the patient was woken up with a pressure on the chest. And third is data from such studies can be used to identify patients so that treatment can begin on time.
Dr Malhotra emphasized that this is important to treat the cause of heart failure, to prevent progression of the disease. The patient is first given medications which are the pillars of heart failure management.If the patient does not improve with these medications, then he is a candidate for CRTD or Cardiac Resynchronization Therapy Devices that are like a pacemaker device to regulate the pumping efficiency of the heart. Even after exhausting these options, if patient does not show improvement, then he is a candidate for Left Ventricular Assist Device or a Heart Transplant.
Left Ventricular Assist Devices are also known as artificial or mechanical heart, which support the left ventricle of the heart to pump efficiently. If a twenty-year-old patient has been operated for LVAD, that will improve his quality of life and his life span will dramatically increase by at least fifteen to twenty years. Many patients have been seen to enjoy sports such as horse riding and paragliding post LVAD.
Heart transplant is suggested in patients with last stage of heart failure, so that patient can enjoy a normal life, provided if they take their immunosuppressive drugs on time. The major drawback with heart transplant is the lack of availability of the organ. Heart transplant numbers are static worldwide. There were close to a hundred transplants last year.
Doctors underscored the critical role of self-management to prevent heart failure. The modern-day heavy reliance on junk food and processed food are to be given up for good, as they are rich in trans-fat, which eats away our heart muscles and increases the risk of heart failure. It is important to stick to a healthy diet comprising of leafy green vegetables, fruits, low salt consumption, whole grains, low fat, and to monitor fluid intake. Patients and caregivers to follow doctor’s advice to control blood sugar within prescribed limit, exercising daily, maintaining body weight and regular with the prescribed medicines. People need to accept that smoking is poison and is to be avoided completely for a healthy heart. .
People should not give in to the stigma of heart failure. The advancement in medical science has treatment options for all stages of heart failure. Early recognition, diagnosis, intervention, prevention, lifelong commitment, and willingness to improve life are the pillars to manage heart failure.
Remember, heart failure isn’t about stopping. It’s about starting life in a new way. To know more about how to manage heart failure visit https://www.toibeatheartfailure.com/patientguide.php Disclaimer: “The views and opinions expressed in the article by the panelists/experts are based on their independent professional judgement and are disseminated in public interest. These views should not be considered as a substitute for professional advice of a registered medical practitioner. The purpose of this article is not to promote any medical procedures or medication and/or recommend a certain doctor. For any specific health issues, please consult your registered medical practitioner.” PWR PWR
