At a clinic I was working in last year, a patient of mine came in very short of breath. On asking her some question, examining her, and reviewing her file, it was clear she had heart failure. She had never really heard of heart failure and exclaimed, "at least it is not cancer." She desperately wanted to get better so she could go to her daughter's destination wedding. I found out later on that she wasn't able to go as her symptoms significantly worsened.
As I thought about this some more, I realized that many patients with heart failure are unclear about what exactly they have. Heart failure is not a distinct disease, such as cancer or having a heart attack. Heart failure describes a group of symptoms that arises from problems with the heart's ability to pump blood.
The most common cause of heart failure is a heart attack. Long-standing high blood pressure, diabetes, inherited heart diseases, drugs and toxins (such as alcohol and some cancer drugs), along with a whole host of other conditions can also cause heart failure. These conditions result in an inability of the heart to pump blood effectively. As a result, fluid accumulated in the lungs, abdomen, and extremities. The most typical symptoms are breathlessness and fatigue. Patients have difficulty sleeping and often use several pillows or sleep upright because of fluid accumulation in the lungs. Those with heart failure often develop significant swelling in their legs. Due to the heart's reduced ability to pump blood, other organs such as the kidney and bone marrow, become dysfunctional. Even the body's muscles do not work as effectively in patients with heart failure, resulting in significant weakness.
Patients with heart dysfunction can remain without symptoms for months, years, or even decades. However, once symptoms develop, other organs worsen quickly. The severity of symptoms also worsens rapidly and patients are admitted to hospital frequently.
Heart failure places a tremendous burden to healthcare systems and is the most common cause of hospitalization in high-income countries in patients over the age of 65. While there has been a decline in heart failure hospitalization among many European countries, until recently, heart failure hospitalization have been increasing in the United States. Approximately 1 million hospitalization in the United States have a primary diagnosis of heart failure and greater than 3 million physician visits per year have a primary diagnosis of heart failure. The cost of heart failure to the United States are significant, and most direct and indirect costs are estimated at $39.2 billion in 2010. In 2008, the HF life cost per individual patient was $110,000/year with 75% of this cost being attributed to in-hospital care.
Studies in Medicare patients have shown that of those admitted into hospital with heart failure, one in ten will pass away 30-days after discharge. Even more staggering is among patients who develop heart failure, 50 percent will pass away within five years. This mortality rate is worse than many cancers. I thought about this statistic as I was treating my patient in the clinic.
Heart failure is like a cancer -- a potentially long standing disease that requires extensive treatment, constant follow-up,and the ever present threat of re-occurrence. While there have been recent advances in medical therapies, more research is desperately needed to help improve the lives of those with heart failure, so that no one would ever have to miss a daughter's wedding.