About 6.2 million adults in the U.S.s are living with heart failure and there are almost 900,000 new cases diagnosed each year. The course of treatment and patient prognosis can vary greatly by individual.
With February being American Heart Month, Colorado Community Media caught up with Miriam Halazon, a nurse practitioner with The Medical Center of Aurora’s Heart Failure Clinic. Below are answers to questions involving heart failure.
Does heart failure mean my heart has stopped working or may stop working?
For many the diagnosis of heart failure is terrifying, as the word “failure” instills fear of imminent death. While heart failure is a serious chronic condition, and it does require medical management, there are therapies that improve outcomes, including longevity and quality of life.
Heart failure means the heart has become weak and is not able to pump blood the way it should. A healthy heart is a strong muscle that pumps blood continuously through the circulatory system, beating in an organized way, supplying oxygen-rich blood to the body’s cells. When you have heart failure, the heart is unable to keep up with the workload. It keeps working but can’t pump enough blood to the body to meet its needs for nutrients and oxygen. Heart failure can worsen over time and requires watchful care and treatment.
Many people with heart failure lead normal, active lives because they take care of themselves by improving their lifestyle including eating healthy, exercising, showing up for appointments with a heart failure provider, and taking medications correctly.
Once a patient with heart failure is perscribed medication, are they good to go?
Medication is an important cornerstone of heart failure management. Evidence-based research has provided clinical data which shows improvement in outcomes when patients are managed appropriately with medical therapy. Through the use of clinical data, standardized medical treatment guidelines have been developed and are recommended through organizations such as American Heart Association, American College of Cardiology, and Heart Failure Society of America.
Medication management is dependent upon your type of heart failure. For many patients, this may include between four and six different medications. With each medication there is an optimal recommended dose.
These medications work to improve heart muscle function. Unfortunately, starting all the recommended medications at their optimal dosing is not well tolerated. When starting these medications there is an art to the medicine – starting the medications and increasing dosing is a collaborative practice between patient and physician which occurs over several weeks to months.
It is important for patients to be active participants in their care, noting how they feel on their medications and with each dose increase (side effects), monitoring their blood pressures, and communicating concerns with their provider. In our practice we plan to see patients every week while we are working to get their medications started and titrated up to optimal dosing.
There is a real partnership between doctor and patients. The goal is to help patients move from novice to expert in the understanding and management of their heart failure diagnosis. It is often difficult in other health-care settings to be able to see patients this frequently – but this is the benefit of a specialized heart failure clinic.
Once heart failure improves, can a patient stop taking medications?
No, not at this time. Clinical evidence at this time suggests that we should continue effective treatments indefinitely.
One trial, the TRED-HF trial, was a randomized study in which patients who had improved heart muscle function back to normal were taken off of their medications over a 16-week period. The study had a 44% drop in their heart muscle function within just eight weeks. This trial had limitations, but clearly suggests that we should not discontinue medical treatment once heart muscle function has improved.
What are lifestyle changes that can improve quality of life and outcomes?
1. Diet – limit sodium intake and monitor fluid intake. This should be discussed with guidances provided by a physician as it can change based on heart failure symptoms and severity.
2. Exercise – Exercise helps your heart and it is recommended to get at least 30 minutes per day most days of the week. But again … talk with a health care provider before beginning to exercise to set goals. Sometimes your provider may order cardiac rehab.
Cardiac rehab helps patients in a monitored setting with medical support to regain strength and stamina, achieve nutrition and exercise guidance, track progress, and encourages self-management and independence.
3. Weigh yourself daily – By weighing yourself daily, you can spot changes in weight, which could signal an increase in fluid and exacerbation of heart failure. Early notification to provider of weight changes can improve management.
4. Avoid alcohol – Alcohol damages cells, including heart cells, and can further weaken already weak heart muscles.
5. Stick to medication plan – Medications can’t work if you do not take them as you should. Never stop taking medication without discussing with a doctor first. Discuss all side effects with physician.
(Editor’s Note: The answers in this story were only changed for length, clarity and grammar.)