Safety Zone Heart Failure Can Be Managed with Changes in Lifestyle and Diet

Heart failure is a silent epidemic. It affects almost 5 million Americans and causes more hospitalizations than all forms of cancer combined. In fact, the Heart Failure Society of America expects more than 400,000 new cases to be diagnosed this year.

“It’s a chronic condition that goes into acute phases, and is the number-one cause of hospitalization in people over age 65,” said Ann LeBrun, dedicated education coordinator in the Telemetry Unit at Cooley Dickinson Hospital.

The cost is staggering in terms of both dollars and quality of life. It amounts to $2.9 billion each year, and many patients suffer from the trauma of repeat hospital stays, which LeBrun said are often four to six days in length.

“There are 1 million discharges from hospitals every year due to the problem,” said Dr. Maura Slawsky, Heart Failure Program Director at Baystate Medical Center in Springfield.

But there is a widespread fallacy connected to the condition. “Heart failure doesn’t mean your heart is failing,” Slawsky said. Instead, it means that the heart is unable to pump blood in an efficient manner to organs such as the brain, liver, and kidneys. However, if health-related conditions that can cause the problem — which include high blood pressure or hypertension (narrowing of arteries in the heart) — are not resolved, the heart may in fact become weakened and eventually fail completely.

“About 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the time when patients are admitted for heart failure and we do imaging tests, their hearts look normal,” Slawsky said. “It’s a misnomer to say that their hearts are weak.” She explained that people who experience a sudden onset of symptoms tend to have structural problems or a virus that has affected their heart. But the incidence definitely rises as people age.

“There are many reasons people can go into heart failure, which include a weakened heart, a heart attack, muscle disease, and viruses. But the incidence goes up steeply after age 65 as a result of wear and tear,” Slawsky said. “Most people we see have had things going on for a while.”

In the past, the term ’congestive heart failure’ was used to describe the illness, but today, the problem is simply referred to as ’heart failure,’ because the congestion that results from the heart’s failure to pump blood efficiently is a component of the disease.

The good news is that the condition can be controlled through education and self-monitoring. “When people hear the words ’heart failure,’ they are often fearful,” LeBrun said. “The diagnosis can be frightening, but people can control it to a large degree by monitoring their diet, weighing themselves daily, and making sure they take their medications as prescribed.”

Taking Control

If a person has been diagnosed with heart failure, it is critical for them to monitor their diet on a daily basis. “We tell people to avoid the salt shaker,” LeBrun said. “Some folks look at me in horror when I tell them this because they don’t realize how much salt they are already getting in the foods they eat,” which can include sandwich meats, frozen pizza, canned tuna or salmon, bacon, sausage, instant hot cereals and pancake mixes, popcorn, and canned soup or baked beans. “We saw a big increase in hospitalizations after the recent snowstorm and after Easter because people ate processed foods and ham, which all have sodium as a preservative. And where salt goes, fluid follows.”

Patients with the illness also need to refrain from consuming saturated fats, which are found in whole milk and dairy products and meats such as beef and pork, because they can increase cholesterol, which can clog arteries over time and lead to coronary heart disease or make heart failure worse.

They also must weigh themselves each day and pay close attention to sudden gains. This is so important that, if patients admitted to Cooley Dickinson with heart failure don’t own a scale, the hospital gives them one to take home before they are discharged, LeBrun said.

If a person’s weight changes by three to five pounds over a period of two or three days, it can mean they are retaining fluid, which will increase pressure on the heart and lead to congestion. Their medication may need to be adjusted, and they should call their doctor right away. Although people without heart failure can tolerate weight fluctuations, when the heart is not pumping properly, it can mean danger, LeBrun said. “It’s not about calorie intake. It’s about fluid retention.”

In fact, people with the condition need to become aware of small but meaningful changes, such as whether their shoes are getting tight or whether they are feeling more tired than usual. “Some people say they just don’t feel well and have a general sense of overwhelming fatigue,” LeBrun explained.

These symptoms, along with shortness of breath, especially when lying down, are red flags and should alert the person to the possibility that they may be retaining fluid and need to call their physician. In some instances, the dose of drugs they take, including diuretics, which eliminate excess salt and water in the blood, may need to be increased to prevent hospitalization. In addition, people who smoke are told to quit, and those who drink alcoholic beverages are told to monitor their intake because drinking in excess can exacerbate the problem.

Slawsky said daily exercise is important for everyone, but imperative for people diagnosed with heart failure. “If you have a weakened heart, it is especially important to lead a healthy lifestyle. People can take a walk, swim, ride a bike, or go on an elliptical machine,” she said.

Treatment Options

Heart failure typically develops over time. As the heart muscle weakens, it becomes more difficult for it to keep blood flowing throughout the body. The tests used to diagnose the condition are typically simple and painless and include an echocardiogram, which measures the heart’s ’ejection fraction,’ which is the measure of how well the heart is pumping. People without problems usually have an ejection fraction of 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} or more, while those with heart failure have an ejection fraction of 40{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} or less.

Immediate treatment for the condition includes reducing the backup of fluid and, in some cases, surgery.

But early diagnosis and treatment are important, and by taking appropriate measures to protect their health, people can take actions to prevent heart failure. The Heart Failure Society says risk factors range from high blood pressure and cholesterol to damage to the heart valves, history of a heart murmur, enlargement of the heart, family history of an enlarged heart, or diabetes.

“Diabetes is a disease of the vessels, and the minute you have it, you have a disease equivalent to cardiovascular disease,” Slawsky warned.

Treating the underlying causes of heart failure is critical in controlling the condition, and here education comes into play. Younger patients are more apt to ignore symptoms, while people of all ages can fail to recognize the importance of taking medications exactly as they are prescribed. Experts say it’s easy for people to think they don’t need to take prescription drugs for conditions such as high blood pressure, as they often don’t experience symptoms until the condition becomes severe and begins to affect other systems in the body.

However, each time someone is hospitalized due to congestion, their risk for other problems increases, LeBrun said. “Falls can happen, especially in the elderly, because they are in an unfamiliar environment and are not at the peak of health,” she explained, citing one example. “So, if we can treat people on an outpatient basis and keep them out of the hospital, it will not only save money, but will improve their lives.”

Pumping up Efforts

Cooley Dickinson Hospital is researching the possibility of opening a heart-failure infusion outpatient clinic, which would allow people with heart congestion to receive intravenous drugs that might prevent them from being hospitalized.

“Heart failure is a chronic illness that can lead to death if it not well-managed,” LeBrun said. “But we want people to know that, through education, they can learn to control their symptoms and lead a high quality of life.”