Not long ago, only about half of heart failure patients were alive five years after diagnosis, even with treatment. Now, many heart failure patients survive for decades.
Life may come from dietary restrictions and increased activity, from beta blockers and ACE inhibitors and diuretics. Or it may require mechanical intervention or a heart transplant. There are many options.
Exercise and how well a patient adheres to a medication regimen make a huge difference to survival, says Dr. Patrick Fisher, a cardiologist who specializes in heart failure and transplantation.
Heart failure is the topic of the Deseret Morning News/Intermountain Healthcare Hotline today. From 10 a.m. to noon, Fisher and family nurse practitioner Kismet Rasmusson, both of Intermountain Medical Center's Heart Failure and Treatment Program, will take questions. Call 800-925-8177.
Fisher says many patients survive 20 or 30 years after a heart transplant, the most extreme form of treatment for heart failure and also the only cure for advanced disease. But it's not something everyone needs, and there are limited hearts available. Other factors may also prevent someone from qualifying.
Patients who don't qualify often get great benefit from a left ventricular assist device (LVAD).
Biventricular pacemaker/defibrillators have significantly reduced deaths due to heart failure, synchronizing the ventricles of the enlarged heart to help it pump more efficiently. It also improves ability to tolerate activity and increases the feeling of well-being, he says.
In earlier stages, disease may be controlled with modified diets, exercise and medications.
ACE inhibitors are one of the first lines of treatment, significantly impacting the abnormal growth of the heart muscle, which can reduce how effectively it pumps blood. Beta blockers are pivotal in improving the heart's pumping action. And when that improves, symptoms do, as well. In some cases, heart function returns nearly to normal, Fisher says. Other drugs may keep a patient stable and out of the hospital.
Rasmusson and her colleagues teach patients to enhance their care with a model they call MAWDS medicines, activity, weight, diet and symptoms. That means knowing what medicines they take and why. They shouldn't skip them or stop them without being instructed to. And they need to understand how to adjust them if needed.
The more active someone with heart failure is, the better.
Daily weighing tracks fluid retention. Weight gain means there's a problem and that diuretics, for instance, need to be adjusted. It's tricky sometimes to get the right balance so there's neither fluid retention or dehydration. A side effect of diuretics can be waste of important minerals like potassium and magnesium, which can be life-threatening. It all requires care.
Sodium intake must be severely limited, and that means ferreting out hidden sources.
Patients keep a daily symptom diary that tracks control of the disease, Rasmusson says.
"Following MAWDS is the most important thing they can do for themselves while they live with heart failure. It's essential to have a good partnership with the care provider and stay up to date on immunizations like pneumonia and influenza."Other tips include not smoking and having a good support system to help maintain emotional health, which can plummet in the face of a chronic disease.