Heart Failure: A Growing, Deadlier Condition That Needs More Attention

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February 10, 2020

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The condition known as “heart failure” is misunderstood and often under-diagnosed. Much of the confusion comes from the name. Heart failure does not mean the heart stops. It means the heart is too weak to pump blood through the body as it normally should. The heart keeps working, but the body’s need for blood and oxygen isn’t being met.

Fueled in part by the prevalence of obesity and diabetes, more U.S. adults are dying from heart failure, compared to even a decade ago, recent studies have indicated. And this trend is evident not just in the elderly, which is expected, but in middle-aged and young adults as well.

The most common cause of heart failure is coronary artery disease (CAD), which occurs when arteries that supply blood to the heart muscle become narrowed by buildups of fatty deposits called plaque. Obesity, diabetes and high blood pressure are major risk factors for heart disease. But those conditions can be modified and treated.

Faulty heart valves, damage to the heart muscles, and abnormal heart rhythm are other key risk factors. Survivors of heart attacks can also develop heart failure, which can be misdiagnosed or overlooked after the patient returns to his or her normal life. Heart Failure Awareness Week is observed Feb. 9-15 to help increase education about the severity of this disease.

“Because some risk factors like obesity, diabetes, and hypertension are increasing, then we are going to see more patients with heart failure,” says Sandra Chaparro, M.D., cardiologist and director of the Advanced Heart Failure program at Miami Cardiac & Vascular Institute. “Another factor is our growing population of elderly patients, and those patients tend to develop heart failure as well.  Because of advances in treating acute coronary syndrome, more patients are surviving heart attacks, but they can end up with damage that can lead to heart failure. So we’re going to see an surge in those patients as well.”

Advanced Heart Failure

Of the more than 6 million Americans living with heart failure, about 10 percent have advanced heart failure. When the condition is advanced, conventional heart therapies or treatments no longer work. Neither are strategies to manage symptoms — such as shortness of breath; fatigue; weakness; swelling in the legs, ankles and feet; and rapid or irregular heartbeat.

Someone with advanced heart failure feels shortness of breath and other symptoms even at rest. The U.S. Centers for Disease Control and Prevention (CDC) states that about half of people who develop heart failure will die within five years of diagnosis.

“Yes, and that’s something that we need to emphasize because even some doctors in the community don’t know those numbers and some may underestimate the scope of the problem,” says Dr. Chaparro. “Over five years, prognosis for heart failure is similar to some cancers. So, we need to underscore all the things that we can do to keep heart failure patients stable, like education, risk factor modifications and compliance with medications.”

As part of a major study released last year, researchers examined data from the CDC on deaths from heart failure between 1999 and 2017 among adults 35 to 84 years old.

Between 1999 and 2012, annual heart failure death rates dropped from 78.7 per 100,000 people to 53.7 per 100,000, the researchers found. But after 2012, a reversal occurred, with rates starting to climb, reaching 59.3 fatalities for every 100,000 people by the end of the study period.

Common Signs and Symptoms

“It’s also important to recognize that the presentation of heart failure is not like the typical heart attack, where you may have chest pain and a lot of people recognize that,” says Dr. Chaparro. “Sometimes, heart failure is much more subtle. We need to do a better job of educating the public and the medical community. “

By themselves, any one sign of heart failure may not be cause for alarm, says the American Heart Association (AHA). But if you have more than one of these symptoms, even if you haven’t been diagnosed with any heart problems, report them to a healthcare professional.

Here are common signs and symptoms of heart failure, according to the AHA:

  • Shortness of breath (also called dyspnea)
  • Persistent coughing or wheezing
  • Buildup of excess fluid in body tissues (edema)
  • Tiredness, fatigue
  • Lack of appetite, nausea
  • Confusion, impaired thinking
  • Increased heart rate

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