The heart is essentially a pump. Heart failure is its inability to pump enough blood for organs such as the brain, kidneys and the liver. Ailments such as hypertension, valvular heart diseases, diabetes, coronary artery blocks and primary heart muscle disease can affect the pumping function.
The approximate estimate of heart failure patients in various stages of the disease in India is 1.3 to 4.6 million, but the data are incomplete owing to lack of surveillance. The incidence seems to be rising, probably due to increased awareness, improved post-attack treatment strategies and better long-term survival after valve surgery. In our country 105 million people are above 60 years of age (8.4 per cent) and this number is likely to increase to 376 million by 2050 (that is, to 21.6 per cent). The incidence increases among the elderly. We must gear to face an epidemic of heart failures. Proper management is important as patients are prone to repeated hospitalisations. The economic burden on the family, the hospital system and on health insurance- providers needs to be considered.
Heart failure can result in poor quality of life and early death. Early diagnosis is key. Serial echocardiography is valuable in diagnosis and follow-up. High BP is the most common cause: Undetected or uncontrolled, it can result in heart enlargement and failure. Detection and treatment of contributing factors such as diabetes and valvular disease can be achieved through annual checkups. Lifestyle modification steps include salt restriction and abstinence from alcohol and smoking. Drug therapy is tailored to individual patients.
Valvular disease needs surgical correction. In the late stages, biventricular pacemakers can improve pumping. Some pacemakers are coupled with defibrillators to prevent sudden death in those prone to life-threatening rhythm disturbances. End-stage cardiac failure patients may benefit from transplants, but finding a suitable donor in a timely manner is a matter of chance. Pacemakers and transplants are expensive.
In the western countries heart failure patients are followed up in special clinics to provide focussed care, expert management and rehabilitation. Domiciliary care and follow-up are available options for end-stage disease. Such clinics are yet to become popular in India.
The theme of World Heart Day, that comes up on September 29 this year, is “Power your life”. Heart failure patients need to power their heart muscle first for longevity and better quality of life.
(The author is an interventional cardiologist at Apollo Hospitals, Chennai)
