How to Live Longer With Heart Failure

Interestingly, a study published in January 2017 by the University of Oxford in the journal Family Practice found that survival rates for people in the United Kingdom suffering from heart failure have not improved since 1988, in contrast to cancer survival rates in the country, which have doubled in the last 40 years.

Although there is no cure for heart failure, it’s important to manage the condition with medication and lifestyle changes to prevent it from worsening.

In order to improve life expectancy while living with congestive heart failure, you should know the different stages of the disease and what to do after diagnosis.

The Stages of Congestive Heart Failure

Regardless of the “stage” of heart failure, it is a chronic, long-term heart health condition that can worsen over time. The sooner you begin making lifestyle changes to treat the condition, the better chance you have at improving your outcome.

Stage A

This is “pre–heart failure.” It means you’re at risk of developing heart failure because you or someone in your family has diabetes, high blood pressure, early coronary artery disease, or there’s a family history of cardiomyopathy, a disease of the heart muscle.

“These are the people we want to prevent from getting heart failure,” Dr. Mountis says. Treatment may include changing your diet, watching salt intake, reducing alcohol, increasing exercise, and possibly taking blood pressure medicines or other medication.

Stage B

This diagnosis is also early in the progression of heart failure. It means you already have some changes to the heart that could possibly lead to heart failure. For example, your heart health might also be compromised because of blood pressure, but you don’t have classic symptoms of heart failure — yet. Patients in this stage typically may have had a prior heart attack or have some form of heart valve disease, Mountis says. Treatments could include those from stage A, as well as possible surgery or intervention as treatment for coronary artery blockage, heart attack, or valve disease.

Stage C

Individuals at this stage have been diagnosed with heart failure, and currently have or have previously had signs and symptoms of the condition, including shortness of breath, inability to exercise, swelling of their legs, or waking up short of breath after lying down.

“These are the people who, if you can get them on good regimens of medication, they can have a good, long quality of life. We know medication works on this group of people,” Mountis says. Cardiac rehabilitation can also help people with stage C heart failure recover everyday functions and help them live longer lives and reduce symptoms.

Stage D

This is an advanced stage of heart failure, and these patients are the sickest, Mountis says. “These are the people who, when I see them, we need to talk about a heart transplant, mechanical heart pump, or end-of-life care if we have nothing else to offer,” she says. Patients with this stage of heart failure should see a specialist to help determine the best course of treatment and which options are still on the table. “It’s critical that they see a specialist within a few days of someone telling them they have stage D heart failure,” Mountis says.

Seeking out a specialist may present more treatment options for individuals diagnosed with any stage of heart failure, Mountis adds. She recommends bringing a list of your questions to the appointment, as well as a list of your medication, and a supportive family member. Oftentimes a family member may have noticed symptoms of fatigue or shortness of breath that the patient forgot about, Mountis says.

Can You Get Better After a Diagnosis of Heart Failure?

Heart failure is a chronic, progressive condition, which means it gets worse with time. But even though it doesn’t necessarily get better, managing heart failure the right way can help reduce symptoms and slow down the progression of the condition.

“I try to get patients to understand that this is not a death sentence,” Mountis says.

According to the CDC, 5.7 million people in the United States are living with heart failure. Several conditions can weaken the heart enough to lead to heart failure, including:

• Coronary heart disease or heart attack
• High blood pressure
• Faulty heart valves
• Damage to the heart muscle (cardiomyopathy)
• Inflammation of the heart muscle (myocarditis)
• Congenital heart defects
• Abnormal heart rhythms (heart arrhythmias)
• Other chronic disease, like diabetes, HIV, or thyroid disease

Depending on the stage and severity of condition, some individuals may need more aggressive treatment, Mountis adds. “But it is very possible to live a very good life with a diagnosis of heart failure.”

Living With Congestive Heart Failure: What to Expect

Yes, there are several lifestyle changes you should take into account if you’ve been diagnosed with congestive heart failure. But remember your diagnosis doesn’t mean you should necessarily stop doing things you love.

“You are supposed to be exercising — walking, biking, swimming, or doing light weight exercises,” says Mountis. The American Heart Association recommends at least 30 minutes of moderate intensity aerobic activity at least five days a week for optimal heart health. Avoid exercises that make you feel breathless, and make sure to talk to your doctor before starting a new exercise routine.

Your healthcare provider will also likely suggest dietary changes that can help reduce the swelling associated with congestive heart failure and slow the progression of the condition. Those changes may include following a low- or reduced-salt diet, or reducing how much fluid you drink to lessen the body’s water content.

Other lifestyle changes that can slow the progression of heart failure include:

For some individuals, doctors may prescribe medication, like angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers, beta blockers, and aldosterone blockers. Other drugs that may be prescribed to reduce symptoms include diuretics, and vasodilator, digitalis, and anti-arrhythmia drugs.

If being on medication leads to an improvement of symptoms and your health, your doctor might advise you to stay on them for good, Mountis says, as they may help prolong your life.

Additional reporting by Brianna Wesley-Majsiak.

Heart Failure Patients Too Optimistic

June 3, 2008 — Many people with heart failure may be overly optimistic when it comes to estimating how long they have left to live.

A new study shows nearly two-thirds of people with congestive heart failure overestimate their remaining life expectancy by an average of 40% compared with what’s realistic based on their prognosis.

Heart failure, which occurs when the heart is too weak to pump enough blood to meet the body’s needs, causes 55,000 deaths each year and indirectly contributes to 230,000 more deaths annually in the U.S.

Although there have been recent improvements in congestive heart failure treatment, researchers say the prognosis for people with the disease is still bleak, with about 50% having an average life expectancy of less than five years. For those with advanced forms of heart failure, nearly 90% die within one year.

“Patient perception of prognosis is important because it fundamentally influences medical decision making regarding medications, devices, transplantation, and end-of-life care,” write researcher Larry A. Allen, MD, MHS, of the Duke Clinical Research Institute and colleagues in The Journal of the American Medical Association.

Heart Failure Expectations Unrealistic?

In the study, researchers surveyed 122 people (average age 62) with moderate to advanced congestive heart failure about their perception of their life expectancy.

They found the heart failure patients tended to overestimate their life expectancy by about three years. The average patient survival estimate was 13 years compared with a validated medical model estimate of 10 years.

Overall, 63% of people with heart failure overestimated their remaining life expectancy by an average of 40% compared with medical model predictions. Those who were younger and with more advanced disease were most likely to overestimate how long they had left to live.

During the three-year follow-up period, 29% of the people involved in the survey died. Researchers found no relationship between longer life expectancy perceptions and survival.

Life Expectancy an Individual Matter

“The exact reasons for this incongruity are unknown but they may reflect hope or may result from inadequate communication between clinicians and their patients about prognosis,” write the researchers. “Because differences in expectations about prognosis could affect decision making regarding advanced therapies and end-of-life planning, further research into both the extent and the underlying causes of these differences is warranted.”

In an editorial that accompanies the study, Clyde W. Yancy, MD, of Baylor University Medical Center in Dallas, writes that predicting life expectancy in people with heart failure is not an exact science and many questions remain about clinical prediction models.

Therefore, until these issues are fully addressed, people should embrace an individualized decision-making process regarding end-of-life care guided by physician input.

Types, Symptoms, Causes & Treatments

Overview

2015 Medical Innovation: New drug for Heart Failure.

What is heart failure?

The term “heart failure” can be frightening. It doesn’t mean the heart has “failed” or stopped working. It means the heart doesn’t pump as well as it should.

Heart failure is a major health problem in the United States, affecting about 5.7 million Americans. About 550,000 new cases of heart failure occur each year. It’s the leading cause of hospitalization in people older than 65.

If you have heart failure, you’ll enjoy better health and quality of life if you take care of yourself and keep yourself in balance. It’s important to learn about heart failure, how to keep in good balance, and when to call the doctor.

How common is heart failure?

Almost 6 million Americans have heart failure, and more than 870,000 people are diagnosed with heart failure each year. The condition is the leading cause of hospitalization in people over age 65.

Heart failure and aging

Although the risk of heart failure does not change as you get older, you are more likely to have heart failure when you are older.

Women and heart failure

Women are just as likely as men to develop heart failure, but there are some differences:

• Women tend to develop heart failure later in life compared with men.
• Women tend to have heart failure caused by high blood pressure and have a normal EF (ejection fraction; see below).
• Women may have more shortness of breath than men do. There are no differences in treatment for men and women with heart failure.

What are the types of heart failure?

There are many causes of heart failure, but the condition is generally broken down into two types:

Heart failure with reduced left ventricular function (HF-rEF)
The lower left chamber of the heart (left ventricle) gets bigger (enlarges) and cannot squeeze (contract) hard enough to pump the right amount of oxygen-rich blood to the rest of the body.

Heart failure with preserved left ventricular function (HF-pEF)
The heart contracts and pumps normally, but the bottom chambers of the heart (ventricles) are thicker and stiffer than normal. Because of this, the ventricles can’t relax properly and fill up all the way. Because there’s less blood in the ventricles, less blood is pumped out to the rest of the body when the heart contracts.

What is ejection fraction?

Ejection fraction (EF) refers to how well your left ventricle (or right ventricle) pumps blood with each heart beat. Most times, EF refers to the amount of blood being pumped out of the left ventricle each time it contracts. The left ventricle is the heart’s main pumping chamber.

Your EF is expressed as a percentage. An EF that is below normal can be a sign of heart failure. If you have heart failure and a lower-than-normal (reduced) EF (HF-rEF), your EF helps your doctor know how severe your condition is.

How is EF measured?

Ejection fraction can be measured using:

Why it’s important to know your EF

If you have a heart condition, it is important for you and your doctor to know your EF. Your EF can help your doctor determine the best course of treatment for you. Measuring your EF also helps your healthcare team check how well our treatment is working.

Ask your doctor how often you should have your EF checked. In general, you should have your EF measured when you are first diagnosed with a heart condition, and as needed when your condition changes.

What do the numbers mean?

Ejection Fraction (EF) 55% to 70%

• Pumping Ability of the Heart: Normal.
• Level of Heart Failure/Effect on Pumping: Heart function may be normal or you may have heart failure with preserved EF (HF-pEF).

Ejection Fraction (EF) 40% to 54%

• Pumping Ability of the Heart: Slightly below normal.
• Level of Heart Failure/Effect on Pumping: Less blood is available so less blood is ejected from the ventricles. There is a lower-than-normal amount of oxygen-rich blood available to the rest of the body. You may not have symptoms.

Ejection Fraction (EF) 35% to 39%

• Pumping Ability of the Heart: Moderately below normal.
• Level of Heart Failure/Effect on Pumping: Mild heart failure with reduced EF (HF-rEF).

Ejection Fraction (EF) Less than 35%

• Pumping Ability of the Heart: Severely below normal.
• Level of Heart Failure/Effect on Pumping: Moderate-to-severe HF-rEF. Severe HF-rEF increases risk of life-threatening heartbeats and cardiac dyssynchrony/desynchronization (right and left ventricles do not pump in unison).

Normal Heart. A normal left ventricular ejection fraction (LVEF) ranges from 55% to 70%. An LVEF of 65%, for example means that 65% of total amount of blood in the left ventricle is pumped out with each heartbeat. Your EF can go up and down, based on your heart condition and how well your treatment works.

HF-pEF. If you have HF-pEF, your EF is in the normal range because your left ventricle is still pumping properly. Your doctor will measure your EF and may check your heart valves and muscle stiffness to see how severe your heart failure is.

HF-rEF. If you have an EF of less than 35%, you have a greater risk of life-threatening irregular heartbeats that can cause sudden cardiac arrest/death. If your EF is below 35%, your doctor may talk to you about treatment with an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT). Your doctor may also recommend specific medications or other treatments, depending on how advanced your heart failure is. Less common treatment options include a heart transplant or a ventricular assist device (VAD). If your quality of life is very poor or your doctor has told you that your condition is very severe, please ask about other possible treatments.

Some patients have HF-rEF (and an EF lower than 40%) and signs of HF-pEF, such as a stiff (but not always enlarged) left ventricle.

Symptoms and Causes

What are the symptoms of heart failure?

There may be times that your symptoms are mild or you may not have any symptoms at all. This doesn’t mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe, and may come and go.

In general, heart failure gets worse over time. As it worsens, you may have more or different signs or symptoms. It is important to let your doctor know if you have new symptoms or if your symptoms get worse.

Common signs and symptoms of heart failure

• Shortness of breath or trouble breathing. You may have trouble breathing when you exercise, or when you rest or lie flat in bed. Shortness of breath happens when fluid backs up into the lungs (congestion) or when your body isn’t getting enough oxygen-rich blood. If you wake up suddenly at night to sit up and catch your breath, the problem is severe and you need medical treatment.
• Feeling tired (fatigue) and leg weakness when you are active. When your heart does not pump enough oxygen-rich blood to major organs and muscles, you become tired and your legs may feel weak.
• Swelling in your ankles, legs and abdomen; weight gain. When your kidneys don’t filter enough blood, your body holds onto extra fluid and water. Extra fluid in your body causes swelling edema and weight gain.
• Need to urinate while resting at night. Gravity causes more blood flow to the kidneys when you are lying down. So, your kidneys make more urine and you have the need to urinate.
• Dizziness , confusion, difficulty concentrating, fainting. You may have these symptoms because your heart isn’t pumping enough oxygen-rich blood to the brain.
• Rapid or irregular heartbeats (palpitations): When your heart muscle does not pump with enough force, your heart may beat faster to try to get enough oxygen-rich blood to major organs and muscles. You may also have an irregular heartbeat if your heart is larger than normal (after a heart attack or due to abnormal levels of potassium in your blood).
• A dry, hacking cough. A cough caused by heart failure is more likely to happen when you are lying flat and have extra fluid in your lungs.
• A full (bloated) or hard stomach, loss of appetite or upset stomach (nausea).

It is very important for you to manage your other health conditions, such as diabetes, kidney disease, anemia, high blood pressure, thyroid disease and asthma or chronic lung disease. Some conditions have signs and symptoms that are similar to heart failure. If you have new or worsening non-urgent symptoms, tell your healthcare provider.

What causes heart failure?

Heart failure can be caused by many medical conditions that damage the heart muscle. Common conditions are:

• Coronary artery disease (also called coronary atherosclerosis or “hardening of the arteries”) affects the arteries that carry blood and oxygen to the heart (coronary arteries). The normal lining inside the arteries breaks down, the walls of the arteries become thick, and deposits of fat and plaque partially block the flow of blood. Over time, the arteries become very narrow or completely blocked, which causes a heart attack. The blockage keeps the heart from being able to pump enough blood to keep your organs and tissues (including your heart) healthy. When arteries are blocked, you may have chest pain (angina) and other symptoms of heart disease.
• Heart attack. A heart attack happens when a coronary artery suddenly becomes blocked and blood cannot flow to all areas of the heart muscle. The heart muscle becomes permanently damaged and muscle cells may die. Normal heart muscle cells may work harder. The heart may get bigger (HF-rEF) or stiff (HF-pEF).
• Cardiomyopathy. Cardiomyopathy is a term that describes damage to and enlargement of the heart muscle not caused by problems with the coronary arteries or blood flow. Cardiomyopathy can occur due to many causes, including viruses, alcohol or drug abuse, smoking, genetics and pregnancy (peripartum cardiomyopathy).
• Heart defects present at birth (congenital heart disease).
• Diabetes.
• High blood pressure (hypertension). Blood pressure is the force of blood pushing against the walls of your blood vessels (arteries). If you have high blood pressure, it means the pressure in your arteries is higher than normal. When blood pressure is high, your heart has to pump harder to move blood to the body. This can cause the left ventricle to become thick or stiff, and you can develop HF-pEF. High blood pressure can also cause your coronary arteries to become narrow and lead to coronary artery disease.
• Arrhythmia (abnormal heart rhythms, including atrial fibrillation).
• Kidney disease.
• Obesity (being overweight).
• Tobacco and illicit drug use.
• Medications. Some drugs used to fight cancer (chemotherapy) can lead to heart failure.

Diagnosis and Tests

Leads on body for an EKG

Heart Failure Diagnosis

In order to determine if you have heart failure, your doctor needs to know about your symptoms and medical history. Your doctor will ask you about things such as:

You will also have a physical exam. Your doctor will look for signs of heart failure and diseases that may have caused your heart muscle to become weak or stiff.

What types of tests are used to diagnose heart failure?

You will have tests to see how bad your heart failure is and what caused it. Common tests include:

• Blood tests help us understand how well your kidneys and thyroid are working. We will check your cholesterol and red blood cell levels for high cholesterol and anemia. Anemia means the hemoglobin (HE-mo-globe-in) level in your blood is lower than normal. Hemoglobin is the part of your red blood cells that makes it possible for blood to carry oxygen through the body. Low hemoglobin levels cause you to be tired and have other symptoms that are similar to those of heart failure.
• NT-pro**B-type Natriuretic Peptide (BNP) blood test**. BNP is a hormone that is released into the blood by the lower chambers of the heart (ventricles) in people with heart failure. NT-pro BNP is an inactive molecule that is released in the blood with BNP. The level changes based on how severe your heart failure is. Higher levels of NT-pro BNP mean the ventricles are more stressed. Low levels mean your heart failure is stable. If you have shortness of breath, the level of NT-pro BNP in your blood can help your doctor know if it is caused by heart failure. A level of more than 450 pg/mL for patients under age 50 or 900 pg/mL for patients 50 and older could mean you have heart failure.
• Cardiac Catheterization. If you are scheduled for a catheterization, your doctor may check your EF during the procedure. A catheterization lets your doctor check your heart from the inside. A long, thin tube called a catheter is inserted into an artery in your arm or leg. The doctor uses a special X-ray machine to guide the catheter to your heart. There are two types of cardiac catheterization — left and right. If you have a left heart catheterization, your doctor may inject dye to record videos of your heart valves, coronary arteries and heart chambers (atria and ventricles). A right heart catheterization does not use dye; it lets your doctor know how well your heart is pumping blood.
• Chest x-ray shows the size of your heart and any fluid build-up around your heart and lungs.
• Echocardiogram (echo). This is an ultrasound to see how well your heart can pump and relax, to check your heart valves, measure your heart and check blood flow. Images are captured using an ultrasound wand that is moved around on the skin of your chest. An echo is often done with a Doppler test so your doctor can see changes in the pressure inside your heart chambers and in the way your blood flows across your heart valves. This is the most common way to determine your EF.
• Ejection fraction (EF). Your EF is a measurement of the blood pumped out of your heart with each beat. Your EF can be measured using an echocardiogram (echo), multigated acquisition (MUGA) scan, nuclear stress test, magnetic resonance imaging (MRI) or during a cardiac catheterization. Ejection fraction is reported as a percentage. A normal EF is between 55% and 70%. Your EF can get better or worse based on how stable your heart failure is and how well your treatment for heart failure is working. It is important for your doctor to know your EF. You should have your EF measured when you are diagnosed with heart failure and as often as your doctor recommends.
• Electrocardiogram (EKG or ECG). This test records the electrical activity in your heart by using electrodes that are connected with wires to an electrocardiograph monitor. Electrodes are small sticky patches that are placed on your body. The wires carry information to the monitor, and it creates a graph to show the electrical activity.
• Multigated Acquisition Scan (MUGA scan) . This test shows your doctor how well the lower chambers of your heart (ventricles) are pumping blood. A small amount of a radioactive dye is injected into a vein. A special camera (gamma camera) is used to create video of your heart as it beats.
• Stress test. This test shows how your heart reacts to stress. You will likely exercise on a treadmill or stationary bike at different levels of difficulty while your heart rate, electrocardiograph and blood pressure are recorded. If you cannot exercise, medication may be used to create the same effect as exercise on your heart (pharmacological stress test).

Other tests may be needed, depending on your condition.

Management and Treatment

How is heart failure treated?

Your treatment will depend on the type of heart failure you have and, in part, what caused it. Medications and lifestyle behaviors are part of every patient’s treatment plan. Your healthcare team will talk to you about the best treatment plan for you. Learn more about heart failure treatment.

What are the stages of heart failure?

Heart failure is a chronic long-term condition that gets worse with time. There are four stages of heart failure (Stage A, B, C and D). The stages range from “high risk of developing heart failure” to “advanced heart failure,” and provide treatment plans. Ask your healthcare provider what stage of heart failure you are in. These stages are different from the New York Heart Association (NYHA) clinical classifications of heart failure (Class I-II-III-IV) that reflect the severity of symptoms or functional limits due to heart failure.

As the condition gets worse, your heart muscle pumps less blood to your organs, and you move toward the next stage of heart failure. You cannot go backwards through the stages. For example, if you are in Stage B, you cannot be in Stage A again. The goal of treatment is to keep you from progressing through the stages or to slow down the progression.

Treatment at each stage of heart failure may involve changes to medications, lifestyle behaviors and cardiac devices. You can compare your treatment plan with those listed for each stage of heart failure. The treatments listed are based on current treatment guidelines. The table outlines a basic plan of care that may apply to you. If you have any questions about any part of your treatment plan, ask a member of your healthcare team.

Stage A

Stage A is considered pre-heart failure. It means you are at high risk of developing heart failure because you have a family history of heart failure or you have one of more of these medical conditions:

• Hypertension.
• Diabetes.
• Coronary artery disease.
• Metabolic syndrome.
• History of alcohol abuse.
• History of rheumatic fever.
• Family history of cardiomyopathy.
• History of taking drugs that can damage the heart muscle, such as some cancer drugs.

Stage A treatment

The usual treatment plan for patients with Stage A heart failure includes:

• Regular exercise, being active, walking every day.
• Quitting smoking.
• Treatment for high blood pressure (medication, low-sodium diet, active lifestyle).
• Treatment for high cholesterol.
• Not drinking alcohol or using recreational drugs.
• Medications:
  • Angiotensin converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB) if you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions.
  • Beta-blocker if you have high blood pressure.

Stage B

Stage B is considered a pre-heart failure. It means you have been diagnosed with systolic left ventricular dysfunction but have never had symptoms of heart failure. Most people with Stage B heart failure have an echocardiogram (echo) that shows an ejection fraction (EF) of 40% or less. This category includes people who have heart failure and reduced EF (HF­ rEF) due to any cause.

Stage B treatment

The usual treatment plan for patients with Stage B heart failure includes:

• Treatments listed in Stage A.
• Angiotensin converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) (if you aren’t taking one as part of your Stage A treatment plan).
• Beta-blocker if you have had a heart attack and your EF is 40% or lower (if you aren’t taking one as part of your Stage A treatment plan).
• Aldosterone antagonist if you have had a heart attack or if you have diabetes and an EF of 35% or less (to reduce the risk of your heart muscle getting bigger and pumping poorly).
• Possible surgery or intervention as a treatment for coronary artery blockage, heart attack, valve disease (you may need valve repair or replacement surgery) or congenital heart disease.

Stage C

Patients with Stage C heart failure have been diagnosed with heart failure and have (currently) or had (previously) signs and symptoms of the condition.

There are many possible symptoms of heart failure. The most common are:

• Shortness of breath.
• Feeling tired (fatigue).
• Less able to exercise.
• Weak legs.
• Waking up to urinate.
• Swollen feet, ankles, lower legs and abdomen (edema).

Stage C treatment

The usual treatment plan for patients with Stage C HF-rEF includes:

• Treatments listed in Stages A and B.
• Beta-blocker (if you aren’t taking one) to help your heart muscle pump stronger.
• Aldosterone antagonist (if you aren’t taking one) if a vasodilator medicine (ACE-I, ARB or angiotensin receptor/neprilysin inhibitor combination) and beta-blocker don’t relieve your symptoms.
• Hydralazine/nitrate combination if other treatments don’t stop your symptoms. Patients who are African-American should take this medication (even if they are taking other vasodilator medications) if they have moderate­ to-severe symptoms.
• Medications that slow the heart rate if your heart rate is faster than 70 beats per minute and you still have symptoms.
• Diuretic (“water pill”) may be prescribed if symptoms continue.
• Restrict sodium (salt) in your diet. Ask your doctor or nurse what your daily limit is.
• Keep track of your weight every day. Tell your healthcare provider if you gain or lose more than 4 pounds from your “dry” weight.
• Possible fluid restriction. Ask your doctor or nurse what your daily fluid limit is.
• Possible cardiac resynchronization therapy (biventricular pacemaker).
• Possible implantable cardiac defibrillator (lCD) therapy.

If the treatment causes your symptoms to get better or stop, you still need to continue treatment to slow the progression to Stage D.

Stage D and reduced E

Patients with Stage D HF-rEF have advanced symptoms that do not get better with treatment. This is the final stage of heart failure.

Stage D treatment

The usual treatment plan for patients with Stage D heart failure includes:

• Treatments listed in Stages A, B and C.
• Evaluation for more advanced treatment options, including:
  • Heart transplant.
  • Ventricular assist devices.
  • Heart surgery.
  • Continuous infusion of intravenous inotropic drugs.
  • Palliative or hospice care.
  • Research therapies.

Stages C and D with preserved EF

Treatment for patients with Stage C and Stage D heart failure and reserved EF (HF-pEF) includes:

• Treatments listed in Stages A and B.
• Medications for the treatment of medical conditions that can cause heart failure or make the condition worse, such as atrial fibrillation, high blood pressure, diabetes, obesity, coronary artery disease, chronic lung disease, high cholesterol and kidney disease.
• Diuretic (“water pill”) to reduce or relieve symptoms.

YOU ARE THE MOST IMPORTANT PART OF YOUR TREATMENT PLAN!

It is up to you to take steps to improve your heart health. Take your medications as instructed, follow a low-sodium diet, stay active or become physically active, take notice of sudden changes in your weight, live a healthy lifestyle, keep your follow-up appointments, and track your symptoms. Talk to your healthcare team about questions or concerns you have about your medications, lifestyle changes or any other part of your treatment plan.

Outlook / Prognosis

What is the outlook?

With the right care, heart failure will not stop you from doing the things you enjoy. Your prognosis, or outlook for the future, will depend on how well your heart muscle is working, your symptoms and how well you respond to and follow your treatment plan.

Living With

How does heart failure affect quality of life and lifestyle?

With the right care and treatment plan, heart failure may limit your activities, but many adults still enjoy life. How well you feel depends on how well your heart muscle is working, your symptoms and how well you respond to and follow your treatment plan. This includes caring for yourself (taking medications, being active, following a low-sodium diet, keeping track of and telling your healthcare provider about symptoms that are new or get worse) and living a healthy lifestyle (regular follow-up visits with your healthcare provider, yearly flu shot).

Because heart failure is a chronic long-term illness, talk to your doctor and your family about your preferences for medical care. You can complete an advance directive or living will to let everyone involved in your care know your desires. A living will details the treatments you do or don’t want to prolong your life. It is a good idea to prepare a living will while you are well in case you aren’t able to make these decisions at a later time.

Heart Failure: Prognosis and Life Expectancy

If you have been diagnosed with congestive heart failure, you may have many questions, such as can heart failure be treated, what are the stages of heart failure, and what is the prognosis? The term heart failure can be misleading because when we hear the word ‘failure,’ we tend to think that something stops working altogether. This isn’t the case with heart failure. A diagnosis of heart failure means your heart isn’t pumping blood as well as it should be. However, it is a chronic progressive condition that has no cure.

Heart failure is very common, affecting almost 6 million people in the United States. It can occur at any age, even in children, although it tends to affect older people than any other group. There is no cure for heart failure, but treatments can help prolong life and quality of life. Learn more about heart failure survival rates, and what you might do to help improve your odds of living with congestive heart failure.

According to statistics, every year about 550,000 people in the United States are diagnosed with heart failure. Some cardiologists describe heart failure by stages. They indicate the risk and/or severity of the condition:

• A: No signs of structural damage to the heart or symptoms or heart failure, but you are at high risk of developing heart failure.

• B: No signs or symptoms of heart failure, but tissue damage can be seen with imaging tests, such as MRI (magnetic resonance imaging).

• C: Symptoms of heart failure and damage to the heart.

• D: Serious signs and symptoms of heart failure.

Other doctors use a classification system called the New York Heart Association (NYHA) classification, or functional classification:

• 1: You have heart disease but don’t have any symptoms and you don’t have to limit everyday physical activity.

• 2: You have mild symptoms of heart disease that may slightly limit your regular physical activities.

• 3: You experience enough symptoms to significantly limit your ability to be active. You only feel comfortable when you are resting.

• 4: You have severe symptoms and limitations. You even have symptoms while resting.

Diagnosing Heart Failure Before It Shows

If you have no symptoms or signs of heart failure, how can you be diagnosed with heart failure? Some people are at a much higher risk of developing heart failure than others. By diagnosing you with stage A heart failure, your doctor will monitor your heart health closely, and suggest treatments (such as medication) that may ward off heart failure signs for as long as possible. A few examples of people who are at risk of developing heart failure include those who have:

As with most medical conditions, the prognosis for heart failure greatly depends on what stage you are in and your treatment plan. The best way to improve your chances of living longer with the best quality of life possible is by working together with your healthcare team on your treatment plan.

How long someone lives with congestive heart failure depends not only on the cause, but the patient’s age and gender:

• Age: The younger you are, the longer you might be able to live with heart failure.

• Gender: Women tend to live longer with heart failure than men, although it may take longer for women to be diagnosed with it in the first place, compared to men.

• Cause: Certain conditions contribute to a poorer prognosis. For example, patients diagnosed with amyloidosis or hemochromatosis, HIV infection, ischemic heart disease, or a connective tissue disease seem to progress through heart failure more quickly than patients with heart failure from other causes.

Researchers are studying if race may play a role in survival, but results aren’t consistent. Some studies show that black patients with heart failure may live longer than non-black patients, but some say the opposite, and others say there is no difference. More research is needed in this area.

Heart Failure Survival Rates

The survival rates from heart failure have been improving over the years. The improvement is slow, but gradual. Clinicians measure overall patient survival from a disease by comparing large groups of people with the disease to large groups of the same age range without it. For example, a 1-year survival rate of 90% is good. It means people with the disease are 90% as likely as people without the disease to be alive for at least one year after diagnosis. For heart failure, the 1-year survival rate rose from 74% in 2000 to about 81% in 2016. The 5-year survival rate increased from 41% to 48%, and the 10-year survival rate rose from about 20% to 26%.

Keep in mind prognosis and life expectancy information is based on data registries from several years ago (it takes a few years to compile the data and make it available for the medical community and patients). Someone diagnosed with heart failure today may have a better prognosis because heart failure treatment, including heart transplant, improves with time.

If you or a loved one has heart failure and you would like to know more about your case, ask your doctor how your age, overall health, and treatment affect your prognosis and life expectancy. Knowing what to expect can help you make plans for the time you have.

Final Stages of Heart Failure: End-Stage Heart Failure

If you or a loved one have heart failure, it’s important to plan for the future. By knowing what to expect, you’ll be able to make the best decisions about your care and ensure that your needs and wishes are met.

Treatments and lifestyle changes can help people live well with heart failure and delay its progression. Even in the final stages of heart failure, proper care can keep people comfortable and help them make the most of their remaining time.

What is End-Stage Heart Failure?

Heart failure is a gradual weakening of the heart, which prevents the heart from pumping as well as it should. Over time, the condition causes other damage to the body.

At first, the heart compensates for its weakness by changing: it may stretch, enlarge, and pump faster. The body also changes, narrowing blood vessels and diverting blood from certain organs. (As a result, many people are not even aware they have a problem during the early stages of heart failure.)

Despite these adjustments, heart failure will continue to worsen, and the body will eventually be unable to compensate for the lack of blood flow. At that point, the person may start experiencing fatigue, breathing difficulties, and other issues.

Various treatments can help people manage these symptoms and slow the disease’s progression. However, heart failure is a chronic condition with no cure. Over time, patients will reach the final stages of heart failure.

During these late stages, the person feels breathless even while resting. However, the severity of their symptoms can fluctuate over days or hours.

What are the Symptoms of End-Stage Heart Failure?

Heart Failure: Quick Facts

1. More than 6 million U.S. adults have heart failure.

2. About half of people who develop heart failure die within 5 years of diagnosis.

3. Most people with end-stage heart failure have a life expectancy of less than 1 year.

4. The leading causes of heart failure are diseases that damage the heart, such as heart disease, high blood pressure, and diabetes.

Sources: U.S. Centers for Disease Control and Prevention, American Heart Association, National Institutes of Health.

Heart failure worsens over time, so symptoms are most severe during the final stages. It causes fluid to build up in the body, which produces many of these symptoms:

• Shortness of breath (dyspnea). In the final stages of heart failure, people feel breathless both during activity and at rest.
• Persistent coughing or wheezing. This may produce white or pink mucus. The cough may be worse at night or when lying down.
• Weight gain or swelling (edema) of the feet, ankles, legs, abdomen, or neck veins.
• Tiredness, weakness.
• Lack of appetite, nausea.
• Thinking difficulties, confusion, memory loss, feelings of disorientation.
• Increased heart rate, feeling like your heart is racing or throbbing.
• Frequent urination.

In addition, people in the final stages of heart failure may suffer from:

• depression, fear, insomnia, and isolation
• anxiety about their future
• trouble navigating the health care system

Treatment of End-Stage Heart Failure

Treatments, such as medications and healthier lifestyles, can help people with heart failure live longer, more active lives. Palliative care – which increases comfort and reduces symptoms – can be given alongside other medical treatments.

Some people with end-stage heart failure may also benefit from implanted devices that help the heart pump blood, or from a heart transplant. However, such invasive treatments also carry risks and potential downsides.

It’s important to understand your options – and to have conversations with your doctor and family about the types of care you want to receive. People with heart failure can have many choices to make, even during the final stages. Moreover, your physician or palliative-care provider can help you plan for potential health emergencies and make treatment decisions in advance instead of during a crisis.

When a patient has a life expectancy of six months or less, they become eligible for hospice care – a type of palliative care given at the end of life. Hospice provides extra support and services to help the person live comfortably and have the best possible quality of life. Hospice providers can also help the patient and family plan for future needs and possible scenarios. They have unique expertise in assisting people with these issues.

” Patients with heart failure can deteriorate quickly or die suddenly, so it’s important to discuss end-of-life issues early and often. ” ~ Dr. Stephen Goldfine, Chief Medical Officer, Samaritan Healthcare & Hospice

When to Seek Hospice Care

Even physicians have difficulty determining life expectancy for people with end-stage heart-failure. The condition can be unpredictable, and symptoms can change. However, certain signs can indicate that hospice care would be beneficial, including:

• frequent chest pain (angina)
• abnormal heart rate
• significant fatigue or shortness of breath
• substantial decline in ability to do daily activities, such as self-care
• The patient has already received the best possible treatment(s), which are no longer working well, and the patient is not a candidate for other interventions.
• The patient has received the best possible treatment(s) and has decided to decline further specialized interventions.

People can be reluctant to start hospice, as they may worry it means they’re “giving up” or that it will hasten death. But such concerns are unfounded. In fact, patients and families often wish they had started hospice sooner, because it makes such a positive difference in their lives. And research shows that early admission to hospice results in greater satisfaction with care among patients and family caregivers.

How Palliative and Hospice Care Can Help with End-Stage Heart Failure

Both palliative and hospice care focus on the whole person, including their physical, emotional, social, and spiritual needs. The main difference is that palliative care can be given at any time during a serious illness, and hospice care is given near the end of life – typically when a person’s prognosis is six months or less. (Hospice is a form of palliative care.)

Palliative and hospice care can also provide help with making difficult treatment decisions, such as whether to be resuscitated if the person’s heart stops, or whether to have a tube placed in their throat to help them breathe.

Similarly, people with end-stage heart failure may need to decide when to disable certain medical devices implanted in their body:

• Implantable cardioverter defibrillator (ICD). Patients can have the shock function turned off, or not replace the battery when the current one runs out. Electrical shocks from ICDs can cause unnecessary distress for patients and loved ones at the end of life.
• Left ventricular assist device (LVAD). Typically, the patient decides when this heart pump will be shut off before it is implanted. The decision can be discussed again as the end of life nears. (Unlike with ICDs, LVAD discontinuation can cause rapid changes that can quickly lead to death.)

Learn more about hospice care here.

In addition, the palliative or hospice team can assist with navigating insurance issues, creating advance directives (such as a living will), and other practical matters. And they can support family caregivers through education, respite services, and grief counseling.

Palliative and hospice care can relieve suffering from heart-failure symptoms, including pain, breathlessness, depression, insomnia, and fear. This can be done through medication, therapies, counseling, and other supports. Hospice and palliative care can help a patient feel at peace, emotionally and spiritually. And hospice can enable a serene and dignified death.

The palliative or hospice team can include a physician, nurse, social worker, certified home health aide, spiritual support counselor, trained volunteers, bereavement support, and complementary therapies such as massage. The team works with the patient and family to create a personalized care plan, based on the patient’s needs, goals, and preferences.

Hospice care is typically given where the patient lives – whether at home or in an assisted living facility or nursing home. Hospice can also be provided in a patient’s hospital room or in a dedicated hospice facility. A key benefit of hospice is that it often enables the person to die at home, which is the wish of most people.

People with end-stage heart failure and their families face a complex journey. But help is available so patients can get the right care at the right time, and live each day to its fullest potential.

If you live in South Jersey and have questions about
end-stage heart failure or hospice care for your loved one, please call Samaritan at (800) 229-8183.

Living Well With Heart Failure

It is possible to lead a normal life, even if you have Heart Failure. People who understand their condition make better decisions, live a longer life and feel better.

Introduction

Nearly 5 million people in the United States live with Heart Failure, and 550,000 new cases are diagnosed each year.

When you first learn that you have Heart Failure, you may feel frightened or alarmed. You may also have many questions or concerns. We’re here to help you understand Heart Failure, answer your questions and manage your condition. Understanding Heart Failure, following your doctor’s instructions and following the guidelines provided in this binder can help you successfully manage your Heart Failure. People who understand their condition make better decisions, live a longer life and feel better.

It is possible to lead a normal life, even if you have Heart Failure. Understanding and taking control of Heart Failure is the key to success. Your doctor and healthcare providers will provide guidelines and a treatment plan. It is your responsibility to follow the treatment plan and manage your Heart Failure.

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How does a healthy heart work?

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The heart is a muscle about the size of your fist. The heart’s job is to pump blood, rich in oxygen and nutrients, to all parts of your body. The left ventricle is the main pumping chamber. In a normal heart, the left ventricle ejects 50% or more of its blood volume out into circulation. This percentage is called the ejection fraction or EF.

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What is Heart Failure?

• Heart Failure is not a disease.
• Heart Failure is the name used to describe a set of symptoms.
• Heart Failure is caused by diseases that affect the ability of the heart to pump blood.

What happens with Heart Failure?

The term “Heart Failure” suggests that the heart has stopped working or has “failed”. This is not the case. What it actually means is that the heart is not working as well as it should, and cannot pump enough blood to meet the body’s needs.

This happens because the heart is weakened by conditions or diseases that damage the heart muscle. Most of these conditions weaken the heart little by little, over a period of time.

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Summary of how Heart Failure develops

The heart muscle is weakened by conditions or diseases that damage the heart. The heart’s pumping action becomes less efficient. The body tries to compensate for the heart’s reduced pumping action by

• Increasing hormonal stimulation
• Pumping faster
• Enlarging—the heart chambers stretch and enlarge and the muscle mass may increase in size.

For a time, these adaptations will help continue normal or near-normal heart functions. But sooner or later, these adjustments can actually make matters worse by putting extra strain on the heart.

What causes Heart Failure?

Cardiomyopathy is the general term for a heart that is enlarged or damaged by one of several diseases. Cardiomyopathy can be caused by coronary artery disease, valvular heart disease, viral or bacterial infections that attack the heart, drugs that damage the heart muscle, prolonged alcohol abuse, some metabolic diseases, as well as other causes.

Coronary Artery Disease (CAD) is the most common cause of Heart Failure. CAD is a narrowing of the arteries that supply blood to the heart muscle. Cholesterol deposits clog the arteries, decreasing the supply of blood and oxygen to the heart. This can weaken the heart muscle. Opening the arteries may improve Heart Failure. CAD can result in a myocardial infarction or heart attack. A heart attack occurs when plaque and clotting cause a complete blockage in a coronary artery. The heart muscle that was receiving blood from the blocked artery dies, causing permanent muscle damage. An enlarged heart from CAD or from a prior heart attack may be referred to as ischemic cardiomyopathy. Six out of every seven patients hospitalized with Heart Failure have a history of coronary artery disease, and three out of four have a history of high blood pressure.

Hypertension (high blood pressure) is the second most common cause of Heart Failure. Long standing or poorly controlled blood pressure increases the workload of the heart. Over time the high pressure causes the heart to enlarge and the muscle becomes thick and stiff. When this occurs the left ventricle cannot fill or pump normally. Long standing hypertension is [MISSING COPY]

Valvular Heart Disease is another common cause of Heart Failure. Heart valves control the direction of blood flow through the heart. When valves are damaged they may not open or close properly. Valves may become stiff (stenotic) or they may fail to close completely (insufficient) which can cause a back flow of blood (regurgitation). Either way, blood flow through the heart is impaired and the heart enlarges to compensate. This weakens the heart muscle and Heart Failure develops. Surgical repair or replacement may correct or decrease the progression of Heart Failure.

Other conditions some of which are temporary and treatable, can cause Heart Failure. These include:

• Arrhythmias (irregular, fast or slow pulse)
• Thyroid disease
• Pregnancy
• Obesity
• Unknown causes (idiopathic cardiomyopathy)

Right sided & left sided Heart Failure

When the right side of the heart is not pumping effectively, the blood returning to the heart from the body backs up in the veins. Right sided Heart Failure causes a backup of blood coming into the heart. Symptoms of right sided Heart Failure:

• Swelling in the liver
• Abdominal distention (bloating in the stomach)
• Swelling in the legs and ankles

The blood enters the left side of the heart from the lungs. When the left side of the heart is not pumping blood forward well enough, blood backs up, causing fluid accumulation in the lungs. This is also called congestive Heart Failure. Decreased forward blood flow results in less nourishment to the body’s organs and tissues. Symptoms of left sided Heart Failure:

• Fatigue
• Shortness of breath
• Weakness
• Cough

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How is Heart Failure diagnosed?

To make the diagnosis of Heart Failure the following should be done:

• Health History.
• Physical Exam.
• Chest X-Ray—to evaluate the size and shape of the heart and detect any fluid in the lungs.
• EKG—to determine heart rhythm and search for previous heart damage or thickened heart muscle.
• Blood Test for BNP—a hormone made when the heart is overworked.
• Measure Ejection Fraction (EF)—to gauge effectiveness of the pumping action of the heart. The EF can be determined with an echocardiogram, nuclear scan or angiogram.

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Ejection Fraction (EF) and its importance

Ejection Fraction (EF) is a key indicator of a healthy heart and is frequently used by physicians to determine how well your heart is functioning as a pump. Ejection fraction is the percentage of blood that is pumped out of the heart during each beat. In a healthy heart, 50-75 percent of the blood is pumped out during each beat. Many people with heart disease pump out less than 50% and many people with Heart Failure pump out less than 40%.

Ejection Fraction is one of the many ways doctors classify the type and severity of Heart Failure and damage to the heart muscle.

Ejection Fraction ranges

• An Ejection Fraction above 50% indicates that your heart is pumping normally and is able to deliver an adequate supply of blood to your body and brain.
• An Ejection Fraction that falls below 50% could indicate that the heart is no longer pumping efficiently and is not able to meet the body’s needs.
• An Ejection Fraction of 35% or less indicates a weakened heart muscle. The heart is pumping poorly, which can significantly increase a person’s risk for sudden cardiac arrest.

Measuring your Ejection Fraction

For Heart Failure patients, knowing your ejection fraction is just as important as knowing your blood pressure and your cholesterol. Ejection fraction is often measured using an echocardiogram, a simple and painless test often performed right in the doctor’s office. Ejection faction can also be measured with other tests including:

• Echocardiography
• Cardiac catheterization
• Exercise stress echocardiography
• Nuclear stress testing

A low Ejection Fraction is a serious health risk

Recent medical research shows that people with an ejection fraction of 35% or lower may be at increased risk for Sudden Cardiac Arrest. Sudden Cardiac Arrest is not a heart attack. Sudden cardiac arrest occurs when your heart suddenly starts beating very fast and quivering instead of pumping blood to the body and brain. If untreated, Sudden Cardiac Arrest can lead to death within minutes. If you have a low ejection fraction, your doctor may prescribe medications, recommend lifestyle adjustments or suggest other therapies.

Treatment options: hope and protection from Sudden Cardiac Arrest

The good news is there are several options that can help reduce the risk for sudden cardiac arrest.

• A heart-healthy lifestyle is one. Keeping your heart healthy includes regular exercise, healthful eating, weight management and not smoking.
• Medical therapies play an important role in addressing the underlying medical conditions that can lead to sudden cardiac arrest. For patients with Heart Failure clinical studies have demonstrated certain classes of drugs, including beta blockers and ACE inhibitors, can reduce the risk of sudden cardiac arrest.
• Medical devices can be implanted in certain high risk patients. An Implantable Cardiac Defibrillator (ICD) is a device that detects a heart rhythm that may be dangerous and delivers an electrical shock to restore normal rhythm.

Know your Ejection Fraction number and talk to your doctor. Only your doctor can determine your Sudden Cardiac Arrest risk and treatment options for your condition.

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Is there a cure for Heart Failure?

Heart Failure is a chronic condition that in most cases cannot be cured; however, it can be managed. For most people with Heart Failure, management means self management: taking medications and making positive lifestyle changes.

Your care team

Many people will work together to help you live better with Heart Failure.

• Your primary care provider: This is the person you usually see for health problems. Your primary care provider can be a family practice physician, a general internist, a nurse practitioner or a physician assistant.
• Your cardiologist: This is a physician specializing in the diagnosis and treatment of heart and blood vessel diseases.
• John Muir Heart Failure Tel-Assurance® Program: This is a free program offered to patients who receive care at John Muir. The program uses daily telephone monitoring to keep your doctor informed of your progress. (For more information see reference section).
• Other health care professionals: Many other professionals including nurses, dietitians, pharmacists, rehab specialists, care managers and social workers may contribute to different aspects of your care.
• You and your family: You and your family are at the center of this team! You need to be active participants in your care. This means learning as much as you can about your condition, following your treatment plan and communicating with the rest of your health care team.

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Accepting your diagnosis

As you try to understand and accept what it means to have Heart Failure, you’ll probably feel a range of emotions. Your outlook on the future may also change, depending on your prognosis. Heart Failure can be mild or severe, and people respond differently to treatment. For some people, Heart Failure symptoms are reversible with proper treatment, yet for others, symptoms get worse over time. Managing your feelings is an important aspect of your care. The following are normal emotional stages after a diagnosis of Heart Failure:

• Your initial reaction: Your initial reaction may be shock, disbelief, denial or numbness. For the first few months, you may have a hard time acknowledging your condition. It’s tough to be told you have Heart Failure.
• Adjusting to your condition: For 3-12 months after your diagnosis, you may experience preoccupation, fear, anxiety or anger. You may struggle to integrate new routines into your daily life. From questions of “why me?” to “what if” you will probably move toward more acceptance of your condition. Throughout these emotional stages, be patient with yourself. Adjusting to life with Heart Failure is challenging, but many people have learned to accept their diagnosis and to lead lives filled with a renewed sense of purpose and hopefulness. With time, support and patience, you can too.
• New habits become routine: When new habits become routine and your understanding of Heart Failure improves, you’ll probably begin to feel more peaceful about your diagnosis. You may get satisfaction from the adjustments you’ve made in your life and feel new resolve about the future.

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Taking care of your emotional health

Your diagnosis of Heart Failure, your symptoms and your concern for the future may cause you and your loved ones to feel depressed or worried. Your concerns are normal. As you begin taking charge of your health and making positive changes, you may find these feelings start to fade. However, if negative feelings continue and interfere with your ability to enjoy life, talk to your doctor. Counseling might help you feel better.

Recognizing depression and anxiety

Everyone feels anxious or blue some of the time. But if these feelings persist and they interfere with your ability to do and enjoy daily activities, or if your relationships are affected, you should seek help. People who are depressed often feel tired and have no energy. They may lose interest in sex, have trouble sleeping and lose their appetite. Although fatigue and loss of appetite are also common symptoms of Heart Failure, they are more likely due to depression if accompanied by any of the symptoms listed on the next page. You may be depressed if you have any of the following symptoms for more than 2 weeks:

• Excessive sleepiness
• Feeling worthless or guilty
• Hopelessness
• Suicidal feelings
• Preoccupation with death
• Down mood
• Feeling blue
• Irritability
• Loss of interest in things you used to enjoy
• Withdrawal from others

You may be anxious if you have any of the following symptoms for more than two weeks:

• Excessive worry
• Fear
• Tension
• Feeling keyed up or always on edge
• Restlessness
• Feeling shaky

Many people in our society feel there is some stigma associated with having emotional problems like depression or anxiety. As a result, they may be reluctant to talk to anyone about how they are feeling. However, having emotional problems is nothing to be ashamed about. It is important to recognize and treat depression and anxiety. If you are having difficulty coping with feelings about Heart Failure, you should seek help and support. In other words, if depression and anxiety are interfering with your life or causing distress, it is important for you to seek help from your doctor or nurse.

Tips to help you deal with emotional blues

• Get out and walk every day
• Get dressed every day
• Keep up with activities or hobbies you enjoy
• Share your feelings with your spouse, a friend or clergy member
• Get a good night’s sleep
• Follow your treatment plan

Conserve your energy

Using less energy with daily tasks can help you have more energy to do more activities during the day. You may need to cut down on some of your activities or use energy-saving devices or techniques. If daily self-care or home care activities are too tiring, discuss this with you doctor. Here are some energy saving tips:

• Simplify your tasks and set realistic goals.
• Plan activities (chores, exercise and recreation) ahead of time. Do not schedule too many things to do in one day. Do things that take more energy when you are feeling your best.
• If necessary, rest before and after activities. When you rest, keep your feet up to keep the swelling down.
• If you become tired, stop and rest. You may need to finish on another day or when you feel less tired.
• Do not plan activities right after a meal.
• Get a good night’s sleep.
• Ask for help. Divide tasks among family and friends.
• Use devices and tools such as a walker, shower chair, hand-held shower head or bedside commode.
• Do all of your grooming (shaving, drying your hair, etc.) while sitting.
• Arrange your activities so you do not have to climb up and down stairs many times.
• Avoid extreme physical activity. Do not push, pull or lift heavy objects (more than 10 pounds) that require you to strain.
• For more energy-saving tips, tell your doctor you would like to speak to an occupational therapist or cardiac conditioning specialist.

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Returning to work

If you have been in the hospital for your Heart Failure, your doctor will tell you how soon you can return to work. You may need to change some of your job related activities. This may involve job re-training or taking disability.

Talk to your doctor about the type of job you have. Your doctor can help you decide if your job will affect your heart condition and if you need to make changes.

Traveling and Vacations

You may travel as soon as you are feeling better, but always let your health care provider know when you plan to go and provide a phone number where you can be reached. By following these traveling tips, your vacation will be worry free:

• Always take all of your medications with you and make sure you have enough medications to last throughout your trip.
• If you are traveling by plane, carry your medications with you. Never check them with your luggage. You may need a letter from your health care provider that verifies all of your medications, especially if you are traveling internationally. Pack this letter with your medications.
• Consider wearing an Emergency Medical Identification band.
• Make sure you have your doctor’s phone number.
• Be careful to avoid infection when traveling. In areas where the water might be unsafe, drink bottled water or other beverages (order beverages without ice). Swim only in chlorinated pools.
• Select food and drink with care to avoid illness. It is easy to overeat and to take in too much sodium when you are away from home, especially while eating meals at restaurants.

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What can you do if you have Heart Failure?

Heart Failure is a serious disorder and is usually a chronic illness. Many forms of Heart Failure can be controlled with medication, lifestyle change and correction of any underlying disorder. The success of your treatment plan depends on your active involvement. Following your treatment plan can make you feel better, prevent your Heart Failure from getting worse and help you live longer.

What you can do:

• Take your medicines exactly as directed
• Weigh yourself every day to see if you are retaining fluid
• Follow a low sodium (low salt) diet Monitor your symptoms every day
• Ask your doctor about drinking alcohol
• Control your body weight
• Get regular physical activity
• Quit smoking
• Know your ejection fraction number
• Learn when to consult your doctor or nurse

Your doctor and the health care providers at John Muir Health are here to help you take control and manage your Heart Failure. We are dedicated to your success.

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What You Should Know if Diagnosed with Congestive Heart Failure

The term ‘heart failure’ can sound scary when you first hear it; the word failure alone could keep you up at night. You might think to yourself, “Does this mean that my heart no longer works?” Thankfully, that’s not the case. What it really means is that your heart is not functioning or pumping as well as it could be, and left untreated, it can cause severe damage to your internal organs. Congestive Heart Failure (CHF) is a serious condition, but it doesn’t have to be a death sentence.

You may have to make some significant changes to your lifestyle going forward. It’s important to understand the facts; if you have a proper strategy in place and you understand the triggers, you can better manage your condition.

If you or a loved one is diagnosed with CHF, here are a few things you should know:

1. It doesn’t work in isolation

CHF works closely with other heart diseases and can be caused by a number of cardiac disorders. In fact, heart failure isn’t the actual disease, but rather a result of other conditions.
Thus, having any type of heart disease exposes you to CHF. That’s why, once you have been diagnosed with CHF, it’s important that you seek screening for other possible heart conditions.

2. Life expectancy varies

One of the most pressing questions you might have is, “What’s the life expectancy?”

Unfortunately, there’s no single answer for this. Your doctor will explain this to you. A lot will depend on which stage of your condition you are in and your overall health. The good news is that advancements are constantly being made in treating CHF. However, despite the advancements, 5 years is the life expectancy of about 50% of those diagnosed with CHF. 90% of those in advanced CHF stages will pass away within a year. At moderate stages, patients average 10 years.

One of the reasons why CHF is so dangerous is that it goes undetected for long. With early detection, you have better odds of living a happy life (with the doctor’s prescriptions and dietary changes).

3. Age matters

Research has shown a strong correlation between the incidence and prevalence of CHF and the patient’s age. With advancing age, the condition can get worse.

The diagnosis, however scary, can give hope to patients and their loved ones. By following the doctor’s advice, you can take control of the situation and your quality of life.

4. CHF is NOT a death sentence

While serious, congestive heart failure diagnosis doesn’t mean your life is over. It’s important to understand how manageable it is. By taking the right steps, patients can learn to live a happy and fulfilling life.

Will there be necessary lifestyle changes? Certainly. But it doesn’t mean you have to stop what you’re doing. Do regular physical exercises like walking, swimming, biking, and light-weight exercises. Avoid activities such as running in very hot or very cold weather or doing heavy lifting. Stick to a diet that’s low in sodium and avoid processed foods.

Consult a doctor for the best steps to combat your CHF.

Broken Heart Syndrome: a disease “out of the head” from which you can die

March 5, 2019

Photo author, Getty Images

Your heart may suffer after some sad event, and is responsible for your “broken heart “Your brain is likely to be,” experts say.

Swiss scientists are conducting research on the so-called “broken heart syndrome”.

Psychological stress can cause acute transient left ventricular dysfunction.The syndrome is manifested by the sudden development of heart failure or chest pain, combined with changes in the ECG, characteristic of myocardial infarction of the anterior wall of the left ventricle.

Most often, this syndrome develops against the background of stressful situations that cause strong, often sharply negative, emotions. Such events can be the death of a loved one or separation.

Scientists do not yet have complete clarity as to how this happens. In a publication by scientists in the medical journal European Heart Journal, it is suggested that the syndrome is triggered by the brain’s response to stress.

For the first time “broken heart syndrome” was described by the Japanese scientist Hikaru Sato in 1990 and received the name “takotsubo cardiomyopathy” (from the Japanese “takotsubo” – a ceramic pot with a round base and a narrow neck).

Photo Credit, Getty Images

This syndrome is different from a “normal” heart attack, where blood flow to the heart muscle is blocked. Blocking of blood flow to the heart occurs when there is a blood clot in the coronary arteries.

However, the symptoms of broken heart syndrome and heart attack are very similar: first of all, it is shortness of breath and chest pain.

Often, some sad event is a kind of trigger that provokes the onset of the syndrome. However, joyful events that cause strong emotions can also lead to the development of broken heart syndrome. For example, getting married or getting a new job.

Broken heart syndrome can be temporary, in which case the heart muscle will recover in a few days, weeks or months, and in some cases, the development of the syndrome can be fatal.

In Britain, broken heart syndrome is diagnosed in approximately 2,500 patients each year.

Photo author, Christian Templin, University Hospital Zurich

Caption,

X-ray of the heart of a person diagnosed with takotsubo syndrome

Scientists do not know the exact cause of broken heart syndrome. However, it is assumed that this syndrome may be associated with an increase in the level of stress hormones – for example, adrenaline.

Elena Gadri from the University Hospital Zurich, together with her colleagues, studied the brain activity of 15 patients who were diagnosed with broken heart syndrome.

The tomography data showed significant differences in the brain activity of these patients from the picture that was observed in 39 participants of the control group, who were healthy.

Much less association was noted between the areas of the brain responsible for controlling emotions and the body’s unconscious (automatic) responses (such as the heartbeat).

“Emotions are formed in the brain, so it is possible that disease forms in the brain. And then the brain sends the appropriate signals to the heart,” says Gadri.

In order to understand the mechanism of the formation of the syndrome, further research is needed.

Nature of the Syndrome

The Swiss researchers who conducted the study did not have CT scans of the patients before they were diagnosed with broken heart syndrome. Therefore, researchers cannot argue that the reduction in connections between different parts of the brain was a consequence of the development of the syndrome, or the syndrome developed due to a reduction in connections.

“This is a very important piece of research, it will help us better understand the nature of this syndrome, which is often overlooked, and it continues to be a mystery to us,” – says the head of the British organization “Cardiomyopathy” Joel Rose.

“These studies will help us understand what role the brain plays in the formation of the syndrome and why some people are susceptible to the disease and others are not,” says Joel Rose.

“These observations confirm our long-standing assumptions about the special role of the brain-heart connection in the formation of takotsubo cardiomyopathy,” says Dana Dawson, a researcher at the British Heart Foundation.

Living with heart failure

Living with heart failure

The heart is a muscle pump that pumps blood through the vessels to provide the cells of the body with oxygen and nutrients.

• A healthy heart beats 50-80 times per minute
• From the heart, blood moves through the arteries, and returns to the heart through the veins.
• Passing through the lungs, blood binds to oxygen, which is then carried throughout the body along with nutrients obtained from food

What is heart failure?

With heart failure , the left ventricle has to push blood into the aorta with great effort.

Gradually it stretches, its walls become thinner, and the heart takes on the shape of an apple.

The left ventricle is then unable to effectively contract and expel blood into the aorta. Symptoms of heart failure are increasing.

Clinical manifestations of chronic heart failure

Weakness and fatigue

Because the muscles in heart failure do not receive enough blood and oxygen, patients may feel fatigued even after a good night’s sleep.

Loads that were previously well tolerated now cause a feeling of fatigue (a desire to sit or lie down).

Additional daytime rest required.

Your doctor will determine the severity of your condition
based on the condition of your heart muscle and the severity of your symptoms.

At I functional class of heart failure you can practically have no complaints, except for slight weakness and palpitations.

At II Functional class of heart failure

Shortness of breath can occur only with heavy exertion. You begin to experience some limitations in physical activity

At III functional class of heart failure

Shortness of breath may appear with light, normal activities, such as walking or dressing. However, you feel good at peace.

At IV functional class of heart failure

You can feel shortness of breath and palpitations even at rest, any physical activity causes discomfort.

Diagnostics of heart failure

• The doctor will ask you in detail about your medical history and complaints. After that, he will conduct a physical examination (measure the pressure, listen to the heart and lungs, then examine the condition of the skin and subcutaneous fat, etc.).etc.). instrumental and laboratory studies will be assigned.

Electrocardiogram (ECG)

• This test will help determine if you have cardiac arrhythmias and ischemic damage to the heart muscle.

Echocardiography (EchoCG)

• This is a method of ultrasound examination of the heart. It allows you to detect structural disorders of the heart muscle and the condition of the heart valves.Also, using this method, the dimensions of the heart chambers and the rate of blood flow between the chambers are determined.

Research in heart failure

Exercise test

This is an electrocardiographic study during controlled exercise. As physical activity, jogging on a special track (treadmill) or a bicycle is used. With the help of this study, latent disturbances of the blood supply to the myocardium, which do not manifest themselves at rest, are revealed.

Treatment of heart failure

Treatment consists of: Diet, exercise, medication, lifestyle interventions.

Your Role:

• You and your doctor and nurse should be partners in helping you stay healthy.
• Try to understand as much as possible the causes and effects of your illness and the methods of treatment.
• Feel free to ask your nurse and doctor if you have any questions or concerns.
• Before each visit to the doctor or interview with a nurse, make a list of questions you would like to ask. It may be difficult for you to concentrate at the appointment and remember everything that interested you.

Weigh yourself daily and record weight daily

IMPORTANT!

Tell your doctor if your weight changes by more than a kilogram

• Eat a low-salt diet
• Follow your healthcare provider’s approved workout plan
• Take your medication as directed.
• Monitor symptoms and report changes in condition
• Quit smoking
• Try to eat a balanced diet with fruits and vegetables.
• Your condition may require the appointment of a nutritional therapy, discuss with your doctor the need for such an appointment
• Reduce alcohol intake.
• Do not use drugs that you learned about from advertising or from the words of friends. They can cause significant damage not only to your wallet, but also to your health.
• Sleep at least 8 hours daily.

Goals of heart failure treatment

• Life expectancy extension
• Improving heart function or preventing further deterioration
• Control of symptoms of heart failure
• Improving the quality of your life.

Lifestyle change activities

Weight control.

Why should you weigh yourself every day?

• Fluid can accumulate in the subcutaneous fat and abdominal cavity.
• The appearance of edema indicates that negative changes have occurred in your condition. At the same time, your weight can increase very quickly.
• If you weigh yourself daily, you can track changes early enough for your doctor to intensify therapy.

This will help avoid hospitalization.

To ensure that your weighings are reliable:

Weigh yourself every morning

• In the same clothes
• After urination
• Before meals
• On the same scales
• Record the received numbers in a calendar or diary.

Diet for patients with heart failure

• Food should be high-calorie, easy to digest, with a sufficient content of vitamins and protein.
• Limiting fluid intake to less than 1.5 liters is necessary for decompensated heart failure. In normal situations, it is not recommended to consume more than 2 liters of liquid per day.

Drinking alcohol is strictly prohibited for patients with alcoholic cardiopathy. The rest can drink small doses of alcohol (for example, a glass of wine or 50 ml of stronger drinks).

Physical activity

Duration and intensity of physical activity.

Types of loads, their duration and intensity are selected by the doctor depending on the severity of heart failure and some other factors. When exercising, follow these guidelines:

Set the pace yourself – loads (exercises) should not tire you.

Start with warm-up and stretching exercises.

Unless specifically prescribed by a doctor, it is better to avoid the following loads: lifting loads; isometric loads – exercises accompanied by muscle contraction without movement of the limbs or trunk; rhythmic gymnastics; swimming; intense exertion, such as running or jogging.

Only a doctor can tell which types of exercise are good for you

• Typically, these are rhythmic activities lasting from 5 to 30 minutes, for example, walking, exercising on a stationary bike.
• It is these loads that strengthen the muscles and prevent weight loss.

These simple rules will help you practice with pleasure and benefit for the body:

• Never exercise on a full stomach.
• Avoid heat and cold.
• It is better to study in the summer in the morning hours
• In winter, move classes to room
• Avoid weight lifting, contact sports and competitive sports.
• Try to study at the same time of day. Make workouts part of your routine.
• Your breathing will speed up slightly during exercise. If you feel uncomfortable, take a short break and then resume at a slower pace
• Do not exercise that causes chest pain, dizziness, lightheadedness, or shortness of breath.Stop exercising immediately if these symptoms appear.
• Do not take hot showers immediately after exercise. Cool down first
• Set aside time for daytime rest

Watch your heart rate during exercise .

The higher the load, the faster your heart beats.

• Ask your doctor what is the safe range for your heart rate.To keep loads safe, watch your heart rate

and try to keep it in a safe range.

Place your index and middle fingers on the inside of your wrist and press them lightly. Count your heart rate for 15 seconds, and then multiply the resulting figure by 4. This will be the heart rate

of your heart in 1 minute. If you have atrial fibrillation, then this method of counting the pulse cannot be used, consult your doctor about how to control the heart rate in this case.

The importance of rest. People with heart failure need rest during the day. Lie down for a short time with your legs raised, or at least interrupt your daily activities for 15-30 minutes several times during the day. This will give you and your heart the respite you need. You may need to alternate between rest and activity throughout the day.

General rules for treatment

Do not skip taking medications if you are feeling well!

In order to maintain good health in case of heart failure, most drugs must be taken continuously!

Stopping medication can harm your health!

If you still missed a drug intake, then never

do not take two doses at once!

Do not save and do not stretch the drug intake for a longer period by reducing the dose.You should take the doses that have the greatest effect.

• Maintain a Heart Failure Patient Self-Monitoring Diary.
• Enter the complete list of drugs you are taking in the “Diary of Medication”, indicating the doses and times of administration.
• Keep this Patient Diary with you at all times.
• If the doctor changes treatment, do not forget to change the Diary. Most drugs must be taken continuously!
• Try to tie your medication to a regular daily activity, such as brushing your teeth or watching TV news.
• You can set an alarm or timer for the time when you need to take medicine
• Mark the time when you need to replenish your medicine on the calendar.
• Replenish your supply in advance, without waiting for the drugs to run out.

Chronic heart failure

and your psychological state.

For most people, stress is a reality.The term was coined in 1936 by Canadian physiologist Hans Selye. He borrowed a technical concept, meaning stress, pressure, pressure, from the science of the resistance of materials, aptly using it in relation to man.

Factors causing stress-stressors are different. Effort, tension, fatigue, pain, humiliation from public censure, an unexpected need to concentrate as much as possible, and even a major success and a very joyful event – any of these conditions leads to the possibility of stress.The human body reacts to a stressful situation stereotypically, with the same biochemical changes, the purpose of which is to cope with increased demands.

Our body reacts to stress by releasing special “stress” hormones – adrenaline and cortisol. There is an increase in heart rate and an increase in blood pressure, at the same time the level of sugar in the blood rises.

Usually this condition lasts for a limited time, then the person copes with the task assigned to him and all changes return to normal.If stress continues for a long time, your body adapts to the stress, and this adaptation leads to conditions such as high blood pressure, shortness of breath, muscle and joint pain and weakness.

Stress and heart failure are linked and can mutually exacerbate each other. Stress can exacerbate the manifestations of heart failure and, on the other hand, the knowledge that you have heart failure can add an additional contribution to the stress you are experiencing.

Since stress is a part of our life, it is important to learn how to cope with it. Try to identify the source of your stress. Divide the sources of stress into those you can and cannot control.

• It is important to know which actions really contribute to relaxation from the point of view of the physiology of the body, and which only exacerbate stressful effects. Relaxing influences include: Listening to soothing music. Reading. Fishing. Relaxing practices.
• Trying to calm down over a cup of coffee, a cigarette, or a glass of wine will only worsen your condition. Try to learn how to say no. Realize that there are limits on what activity you can do. Don’t forget to laugh.

Depression Facts

• Depression can be one of the symptoms of heart failure and / or a reaction to the fact that you have this disease.
• Symptoms of depression and symptoms of heart failure can be similar (weakness, decreased concentration, decreased interest in sex) and often depression is not recognized in patients with heart failure.
• Depression is not directly related to the severity of heart failure.
• Depression occurs in more than half of patients with heart failure.

The combination of depression and chronic heart failure aggravates the course of the latter, causing more frequent hospitalizations and more severe symptoms.

Head of the Department of Medical Rehabilitation V.A. Toporash

90,000 ✅ Only … – Moscow Health Department – DZM

🏥 Overhaul in the outpatient oncological care center GKOB No. 1 has been completed

It is located at the address: Zagorodnoye Shosse, house 18a, building 9

👍🏼 Sergei Sobyanin examined the center, and also got acquainted with the progress of the repair of the oncosurgical building No. 7 (More on this in the following posts)

“We continue the reconstruction and creation of modern oncological centers.Today, such a center is opening on the basis of the first city cancer clinic. It complies with all modern world standards, providing a full range of diagnostics and therapeutic treatment of patients. The center will be involved in the treatment of residents of the Central District, and in some areas it will work in eight administrative districts of Moscow. The number of people who will be able to receive help here will also increase, and, of course, the quality of treatment will be at a completely different level, ”Sergei Sobyanin said

👴🏻 The center will receive the first patients on October 25

▶ ️ in one place a full cycle of diagnostics and treatment of specialized patients

👨‍⚕️ 👩‍⚕️ Each patient will be provided with an individual approach from the moment of the first visit.