Imagine your heart as the engine helping you drive through life's journey. But with heart failure, your heart stops pumping as well as it should.
In a recent webinar,
Senan Yasar, MD, Ramesh Emani, MD and
Robert Dowling, MD discussed the journey of heart failure—from prevention to breakthrough treatment options—and what you can do to keep your engine running at its best.
Heart failure is on the rise
Heart failure, also called congestive heart failure, develops when your heart doesn't pump enough blood for what your body needs. Overall,
heart failure is rising in the United States.
Black people experience the highest rates of heart failure, whereas the lowest rates are traditionally seen in White and Hispanic populations. The possibility of developing the condition increases with age and occurs more often in men than women.
The lifetime risk of developing heart failure is about 20 percent—or one in five people.
Risk factors and types of heart failure
In addition to older age, gender and race, there are other risk factors for heart failure:
- Coronary artery disease
- Diabetes
- High blood pressure (hypertension)
- Obesity
- Smoking
- Valvular heart disease
There are two major types of heart failure:
-
Preserved ejection fraction—Due to stiffness and sometimes thicker walls, the left ventricle can only fill with a small amount of blood and cannot pump enough to meet the body's needs.
-
Reduced ejection fraction—The left ventricle can fill with enough blood, but it can only pump about 40 percent of its volume before refilling.
Doctors classify heart failure in one of four stages: Stages A, B, C or D, according to severity. If you are in Stage A, you don't have heart failure, but are at risk due to the health factors described above.
How to reduce your heart failure risk
As a cardiologist, Dr. Yasar recommends adopting healthier eating habits to avoid heart failure. Better habits include avoiding fried foods, processed red meat, sugary beverages and lots of salt.
“The DASH diet is a low-sodium diet associated with reducing the risk of heart failure. In simplified terms, it's a plant-based diet with more plant-based fats. It's also high in whole grains, fruits and vegetables, and fish," he says.
By the numbers
To decrease your risk of developing heart failure, Dr. Yasar says it's important to try to reach the following goal numbers:
- Blood pressure less than 130 over 80 mm Hg
- Body Mass Index (BMI) less than 30
- Cholesterol intake of less than 300 mg a day, according to the
American Heart Association (AHA)
- Vigorous exercise 150 minutes a week (30 minutes a day, five days a week)
Also, consider limiting alcohol, quitting smoking and reducing your sodium intake.
Treatment options
If you develop heart failure, physicians consider several factors to determine the treatment that will help you feel better and live longer. Heart failure is a chronic condition, so there is no cure, but physicians can help you manage the condition for both the short and long term, according to Dr. Emani.
“We really develop relationships with patients and family members to find the right combination of therapy options," he says. “Treating heart failure is like building a house. We build a house around your heart to make it better, give it shelter and help it thrive."
To build this “four-walled house" for the heart, Dr. Emani lists four major treatment options.
-
Medications: Beta-blockers, ARNIs or ACEi/ARBs, MRA or SGLT2 inhibitors, along with water pills to reduce symptoms and other advanced medications to reduce the risk of heart failure getting worse.
-
Beta Blockers can lower the heart rate so that the heart does the same amount of work with fewer beats. Some common ones used are Metoprolol, Carvedilol and Bisoprolol.
-
ARNIs or ACEi/ARBs - ARNI stands for angiotensin receptor/neprilysin inhibitor. The only FDA approved ARNI on the market is Entresto. It helps lower blood pressure, get rid of more sodium and makes the blood vessels wider, so the heart does not have to beat so hard. ACEi (angiotensin converting enzyme inhibitor) and ARB (angiotensin receptor blocker) both lower the blood pressure and make the blood vessels wider, so the heart does not have to work so hard. This improves blood flow to the heart. Some common ACEi's used are lisinopril and enalapril. Losartan and telmisartan are common ARBs used.
-
MRA (mineralocorticoid receptor antagonist) help to block hormones that worsen heart failure and help to reduce the amount of fluid buildup. Common ones used are spironolactone and eplerenone.
-
SGLT2 inhibitors (sodium-glucose cotransporter-2 inhibitor) are a class of medicine used to lower high blood glucose levels in people with type 2 diabetes. Common SGLT2 inhibitors include Jardiance and Farxiga.
-
Targeted therapies: Sleep and the cardiovascular system are intimately intertwined. A variety of conditions such as heart rhythm issues, heart attack risk, stroke risk and heart failure risk have been shown to be associated with
sleep disorders. Treatments for sleep apnea (stopping breathing episodes) include:
-
CPAP
(Continuous Positive Airway Pressure)
and BiPAP (Bilevel Positive Airway Pressure) devices to treat sleep apnea. Both machines are worn during sleep and provide pressure that blows through the airway and prevents it from closing off during periods of apnea.
-
Hypoglossal nerve stimulation (Inspire device) is the only approved implantable, non-PAP device on the market right now to treat obstructive sleep apnea (OSA). This works by preventing the tongue from closing off the airway during sleep.
-
Phrenic nerve stimulation (Respicardia device) is the only FDA approved implantable, non-PAP device for central sleep apnea (CSA.) This works by restoring a normal breathing pattern.
-
Surgery: Medications do not work 100 percent of the time. Surgeons can insert a heart pump to help the left ventricle supply blood when medications aren't enough.
Your healthcare team will help guide you through the treatment journey, finding the right combination for a lifelong commitment to feeling better.
Advanced heart failure treatment options
Dr. Dowling believes that prevention methods are the best, but he is working with a team to develop a brand-new artificial heart for advanced heart failure. Previous options, in which development began in the 1970s, usually were built too big for people. Older models could fit about 80 percent of men and 10 percent of women.
The new technology allows pumps to last for decades, possibly up to 40 years. According to Dr. Dowling, The Christ Hospital Health Network will be one of four centers in the United States starting clinical trials following FDA approval.
Researchers across the United States are trying to develop new methods and technology to improve the lives of people with advanced heart failure.
“In the future, we're looking at next-generation pulsatile, implantable, durable and physiologic devices. Implanting these devices without a major operation is our goal," he says.
Live your best life
We're here to help you every step of the way with your heart health. To talk with a Heart and Vascular Institute expert at The Christ Hospital Health Network, call 513.966.4018.