Heart failure: A Case for Prioritizing Prevention

Heart failure was identified as an emerging epidemic in 1997, and has since unfolded into a public health crisis. Heart failure occurs in 550,000 people in the United States each year, and almost 5 million Americans are currently living with the condition. 1 Today, chronic heart failure affects about 2% of the global population, with individuals over age 60 bearing a majority of the disease burden. 2 Survival rates after diagnosis with heart failure are 50% at 5 years and 10% at 10 years, and have remained low despite many available pharmaceutical therapies. 3  Risk factors that may lead to heart failure include high blood pressure, high cholesterol, diabetes, obesity, and exposure to toxic substances like alcohol, certain drugs, or cancer treatment. Many of these risk factors can be caused or made worse by having a sedentary lifestyle lacking regular exercise. 4

Heart Failure: imperfect solutions

At their root, symptoms of heart failure are caused by cardiac abnormalities that lead to elevated pressure within the heart or a reduced cardiac output at rest or under stress. 5  Many pharmaceutical therapies to relieve heart failure symptoms and to improve outcomes of patients with heart failure exist. Medications include diuretics, which help the kidneys remove excess fluids from the body, ACE (angiotensin converting enzyme) inhibitors, which dilate blood vessels making it easier for the heart to pump blood forward, and beta-blockers, which decrease blood pressure, facilitating pumping. A pacemaker uses electrical pulses to help regulate heartbeat. 6 Despite the large number of new and innovative therapies, patient outcomes are still only improving incrementally and remain poor as a whole.

Prioritizing prevention

Prevention of heart failure should be prioritized in the healthcare system. Many risk factors for early heart failure development including hypertension, diabetes, and obesity are amenable to interventions aimed at increasing physical activity and exercise and discouraging sedentary lifestyles. The Centers for Disease Control and Prevention/American College of Sports Medicine consensus statement and surgeon general’s report recommends that “every American adult participate in 30 minutes or more of moderate intensity activity most, and preferably all, days of the week.” Furthermore, regular cardiovascular exercise is known to reduce body weight, blood pressure, bad cholesterol and total cholesterol, and to increase good cholesterol and insulin sensitivity. 7 Additionally, physician-advised exercise-based rehabilitation programs for individuals with diagnosed heart failure have been shown to reduce the risk of hospital readmissions along with providing a slew of parallel health benefits. 8  Individuals with family history of heart failure should take extra care to adhere to exercise guidelines.

Family history can also be a significant and independent risk factor for heart failure. It captures both genetic traits and the environment shared among household members. The exact definition and clinical use of family history is still an active area of research. 9 10  However, in simplest form, if any of an individual’s first degree relatives (siblings and parents) had a cardiovascular event before age 55 for males and age 65 for females, then that person’s risk of developing a heart condition is considered high. If the event occurred at a later age then risk is considered moderate to low. Individuals that meet these family history criteria are advised to let their physician know during yearly physical health examinations, and are even more encouraged to make healthy lifestyle choices.

To encourage uptake of exercise recommendations among the US’s generally sedentary population, action at the community level will be crucial to supplement physician and healthcare worker recommendations. In patients with known cardiovascular risk factors, early screening and preventative treatment can tangibly affect their long-term health. At any age or physical state, prioritizing cardiovascular health will endow numerous current and future benefits to one’s well-being.

 

Notes:

  1. “Heart Failure.” National Heart Lung and Blood Institute, U.S. Department of Health and Human Services, www.nhlbi.nih.gov/health-topics/heart-failure.
  2. Metra, Marco, and John R Teerlink. “Heart Failure.” The Lancet, vol. 390, no. 10106, 2017, pp. 1981–1995., doi:10.1016/s0140-6736(17)31071-1.
  3. Cowie MR, Wood DA, Coats AJ, Thompson SG, Suresh V, Poole-Wilson PA, Sutton GC. Survival of patients with a new diagnosis of heart failure: A population based study. Heart. 2000;83:505–510.
  4. Myers, J. “Exercise and Cardiovascular Health.” Circulation, vol. 107, no. 1, 2003, doi:10.1161/01.cir.0000048890.59383.8d.
  5. Cowie MR, Wood DA, Coats AJ, Thompson SG, Suresh V, Poole-Wilson PA, Sutton GC. Survival of patients with a new diagnosis of heart failure: A population based study. Heart. 2000;83:505–510.
  6. “Heart Failure in Children.” The Children’s Hospital of Philadelphia, The Children’s Hospital of Philadelphia, 24 Aug. 2014, www.chop.edu/conditions-diseases/heart-failure-children.
  7. Myers, J. “Exercise and Cardiovascular Health.” Circulation, vol. 107, no. 1, 2003, doi:10.1161/01.cir.0000048890.59383.8d.
  8. Taylor, Rod S, et al. “Exercise-Based Rehabilitation for Heart Failure.” Cochrane Database of Systematic Reviews, 2014, doi:10.1002/14651858.cd003331.pub4.
  9. Scheuner, M. T., Whitworth, W. C., McGruder, H., Yoon, P. W., & Khoury, M. J. (2006). Expanding the definition of a positive family history for early-onset coronary heart disease. Genetics in Medicine8(8), 491.
  10. Valdez, R., Greenlund, K. J., Khoury, M. J., & Yoon, P. W. (2007). Is family history a useful tool for detecting children at risk for diabetes and cardiovascular diseases? A public health perspective. Pediatrics120(SUPPLEMENT 2), S78-S86.

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