Introduction
Heart failure means the inability of the heart to pump adequate blood into the circulatory system. With less blood flowing in the body, the heart, brain, lungs and the kidney ' every organ, in fact ' gets affected. This can be acute or chronic in nature.
At times, there may be a pre-existing heart condition, such as coronary artery disease, which may suddenly become worse resulting in death from acute heart failure. Heart failure is emerging as an enormous health threat and a complex challenge for health-care professionals. Heart failure is commonly the result of acute and chronic heart injury. These heart injuries can be prevented with aggressive risk factor management, timely diagnosis and treatment, regular follow-ups with heart doctors and complying with therapy.
Epidemiology
According to WHO, 16.7 million individuals died of heart disease (29.2 per cent of deaths globally) in 2003. From 2010, heart diseases have become the leading cause of death in developing and developed countries. In India, every year approximately 4 lakh new patients are being diagnosed with heart failure. The chance of becoming a heart failure patient after 40 is approximately 20 per cent. The estimated annual mortality from heart failure is approximately 21 per cent in men and 17 per cent in women.
The additional yearly health cost for this rising number of heart failure patients is more than Rs 100 crore. The forces of globalisation that lead to industrialisation, urbanisation, unhealthy diets, sedentary lifestyles, obesity and smoking, which have resulted in an epidemic of heart disease in developing countries, are also likely to be contributing to a global rise in heart failure. An alarming increase in diabetes is directly related to a rise in heart failure patients, more so in India.
Clinical facts
Coronary artery disease, hypertension, diabetes, valvular heart diseases, heart muscle inflammation, cardiomyopathy, primary muscle diseases of the heart, frequent untreated palpitation, obesity, excessive alcohol intake, sleep disorders, increasing cholesterol and triglyceride, chronic kidney diseases are leading causes of heart failure. The inadvertent use of drugs like painkillers, long-term use of chemotherapeutic drugs and steroids may increase the chance of heart failure. Genetic mutations, especially after being exposed to many toxins in the environment or as an occupational health hazard like exposure to chemicals and fumes make a person prone to heart failure.
Shortness of breath, more so with exertion, repeated breathlessness at night, palpitations, easy fatiguablity, generalised swelling or swelling of both legs are some symptoms of heart failure.
Certain biomarkers like microalbuminuria especially in diabetics, C-reactive proteins and pro BNP, especially in acute conditions, are important predictors for heart failure prognosis. Chest X-ray, ECG and echocardiography are important tests for heart failure patients.
Management of heart failure is truly multifaceted and a multi-disciplinary team approach. But the most important treatment of heart failure is prevention. Lifestyle modifications ' complete stoppage of smoking, abstinence from alcohol, good control of blood sugar, blood cholesterol, and maintenance of ideal body weight ' is the cornerstone of treatment. Salt and fat restriction, avoidance of excessive calories, deep-fried foods are essential.
If someone has heart disease or has had angioplasty or bypass surgery, regular follow-ups with heart specialists and compliance with prescribed drugs are compulsory. Coexistence of diabetes and kidney disease needs special attention. Diabetes makes existing heart disease complicated. Anti-diabetic drugs must be taken and blood sugar must be properly controlled. Drug therapy for any heart disease or hypertension must not be changed or modified without doctor's advice; the consequence of doing so will be disastrous.
The most important factor directly related to death in heart failure is repeated hospitalisation. The commonest cause of repeated hospitalisation of heart patients is non-compliance with doctors' advice. In advanced heart failure, once the heart function drops below 35 per cent, the prognosis becomes worse.
However, nowadays in advanced heart failure, special pacemaker devices like biventricular pacemaker and/or implantable defibrillator implantation treatment are very effective and they improve the chances of survival and quality of life. About 40 per cent reduction in mortality can be achieved by device therapy in advanced heart failure patients.
Stem cell therapy is an upcoming treatment for advanced heart failure. An active campaign for heart transplantation in our country would be very effective for advanced heart failure. Like in the West, a special heart failure clinic is essential in our country.
Conclusion
Heart failure is the final destination of many heart risk factors and heart diseases. It is a pathetic morbidity of heart patients. Most heart diseases and, in turn, heart failures are preventable by implementation of aggressive lifestyle modification, improving dietary habits and pharmacological interventions. Knowledge of excellent therapeutic benefits of device implantation and campaign for heart transplantation, creating heart transplant bank in our country are essential. On Doctors' Day, awareness of heart failure should include national and international efforts to approach all known risk factors for heart diseases aggressively and bringing awareness about new therapies of heart diseases so that we all can live without the fear of heart ailments.
(The author is the regional director and head, Apollo Gleneagles Heart Institutes.)
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