The Heart Failure Guide & Common misconceptions

Heart failure is a huge challenge for patients, doctors, and healthcare systems

Heart failure is a widespread and devastating condition that affects ~6.2 million Americans and ~64.3 million people worldwide. Sadly, these numbers are only expected to continue increasing. Not only is heart disease a leading cause of death nationwide, but it’s also a leading cause of hospitalization and healthcare costs. In 2012, care and treatment for heart failure cost an estimated $30.7 billion in the U.S.

In case these statistics weren’t dire enough, the treatment and outcomes for patients with heart failure are also grim. Once diagnosed with heart failure,

• 17-45% of patient deaths occur within one year of hospital admission and

• 45-60% of deaths occur within five years of admission.

The day-to-day management of this disease is often a difficult and painful journey for patients and their caregivers. Imagine manually tracking vitals and symptoms, multiple visits to the hospital, difficulty breathing, uncomfortable fluid retention, and even impaired cognitive ability.

The need for innovative solutions to improve patient outcomes, proactively manage heart disease, and reduce healthcare costs has never been greater. Luckily, there are new strategies, treatments, and technologies coming to market that are centered on improving outcomes. But first, let’s explore what heart failure is, its symptoms, and current treatments.

What is heart failure?

Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen. Put simply, when someone has heart failure, their heart is no longer pumping well enough to keep up with the workload.

Heart failure is a clinical syndrome, which means that patients must show signs of symptoms AND have the supporting physiological evidence to call it heart failure. For example, one might be short of breath (symptom) AND their left ventricle may be damaged (physiological evidence).

You can see an example of a normal heart vs. a heart with heart failure by clicking here.

There are different types of heart failure

Left-sided heart failure, right-sided heart failure, and congestive heart failure are all types of heart failure. To better understand how heart failure often starts, it can be helpful to use the analogy of a balloon.

Imagine the heart is a balloon, and as it expands, it fills up with blood (relaxation/diastole) and then it smacks shut to push blood out of the balloon into the body (contraction/systole). For a healthy heart, there are two steps that are both completed with strength and gusto:

1. filling up, and

2. vigorously contracting

In the healthy heart case, the balloon pushes >50% of the blood that’s in the balloon out of the balloon each time it contracts.

There are two ways that this process can deteriorate:

1. In heart failure with reduced ejection fracture (HFrEF, aka systolic heart failure), the balloon expands and fills easily (imagine a slightly floppy balloon), but it doesn’t have the elasticity and strength to contract forcefully, thus only pushing <40-50% of the blood out of the balloon.

2. In heart failure with preserved ejection fracture (HFpEF, aka diastolic heart failure), the balloon has trouble filling (imagine less elasticity or thicker rubber) and needs a lot of pressure to fill the balloon, so that lots of blood spills out of the balloon when it is filled, even though it still contracts forcefully.

Here are some other terms you may hear being used to describe heart failure:

advanced heart failure, congestive heart failure (an antiquated term often used interchangeably), acute heart failure (defined by an event like a heart attack or onset of symptoms), cardiovascular disease (umbrella term to describe cardio-heart + vascular-blood related conditions).

Symptoms of heart failure

The heart tries to make up for the lack of strong blood flow by enlarging, developing more muscle mass, and/or pumping faster to increase the heart’s output. These factors can keep the body functioning, however, they only mask the problems of heart failure. Heart failure continues to worsen until these compensating processes no longer work.

Typically, symptoms include shortness of breath and fatigue that results from a backup of fluid into the lungs and from poor blood flow to the muscles and organs. Some people also have ankle swelling, coughing or wheezing, lack of appetite or nausea, impaired thinking, or increased heart rate. Everyday activities such as walking, climbing stairs, or carrying groceries become challenging.

Hypertension (aka high blood pressure, which is >140 systolic or >90 diastolic according to USPSTF) is the most common comorbidity with heart failure, followed by coronary artery disease and stroke. Others include heart attack, obesity, and diabetes.

Diagnosing heart failure

A diagnosis of heart failure is determined by a clinician – PCP, cardiologist, and/or other specialists. Because the diagnostic measures all require an in-person doctor’s visit - patients may experience signs and/or symptoms of heart failure for an extended period before receiving a diagnosis. Alternatively, patients may experience a sudden onset of symptoms—for example, a heart attack—resulting in an immediate diagnosis of acute heart failure. In all cases, early clinical intervention is highly indicative of patient quality of life and disease prognosis.

If someone is suspected to have heart failure, a typical initial physical examination includes taking blood pressure, weight, and listening to heart and lungs using a stethoscope, as well as a blood draw. The most common tests to determine heart failure severity and diagnosis are: Chest X-rays, Electrocardiogram (ECG or EKG, used interchangeably), Echocardiography (“echo” or “TTE” to measure the heart’s ejection fraction), MRI, exercise stress test, or invasive catheters (coronary angiogram or right heart catheterization).

Treatment and medication management

Statistically speaking, more than half of all patients with heart failure will die within 5 years of diagnosis. Furthermore, heart failure is a leading cause of hospitalization in the United States, and 25% of heart failure patients are readmitted to the hospital within 30 days of discharge.

Although there’s no “cure” treatment for heart failure, the condition can be managed with heart failure medications and healthy lifestyle changes. Preventive measures are needed early to halt the progression of risk factors to the development of heart failure.

Treatment for heart failure is multi-pronged and can include lifestyle changes (e.g. exercising more, eating a low-fat / low-sodium diet), medicines to manage or reduce symptoms (e.g. blood pressure medication), medical devices (e.g. aquapheresis devices that remove excess salt and water from the body), and surgery (e.g. heart transplant). Daily symptom tracking (e.g. weight, blood pressure) is also recommended for patients with heart failure.

Patients with heart failure on average take 6.8 prescription medications per day – appx. 10.1 doses per day. Common medications for heart failure patients include:

• Diuretics (to remove excess fluid from the body),

• Beta-blockers (to lower blood pressure),

• ACE inhibitors (to lower blood pressure),

• ARBs (to lower blood pressure).

Only a small percentage of heart failure patients are on the recommended Guideline Directed Medical Therapies at any given time. According to the CHAMP-HF registry study of 3,500 patients, only 1% were simultaneously receiving target doses of ACE/ARB/ARNI, beta-blocker, and MRA. This is often attributed to a phenomenon called therapeutic inertia, which describes the failure to initiate or intensify therapy when appropriate to do so. One hypothesis is that having access to consistent and reliable in-home health monitoring would allow care teams to better titrate medications towards Guideline Directed Medical Therapies.

Innovations and the future of heart failure treatment

It’s clear that heart failure is one of the world’s greatest health challenges. Not only is it a terrible disease for those suffering from heart failure, but it’s also difficult for caregivers and very expensive to treat. However, there is a wave of companies that are taking advantage of high-tech sensors, advanced algorithms, and artificial intelligence to capture medical-grade health signals from the home and predict deterioration to allow for earlier intervention and improve the overall care of heart failure.

At Casana, our mission is to improve the health and wellness of patients via in-home health monitoring, improve the effectiveness and efficiency of caregivers, and reduce the cost of healthcare for both patients and payors. Hopefully, new innovations from Casana and other health companies will help people manage their heart failure from home, help care teams manage their patient’s conditions remotely, and ensure better outcomes for those affected by heart failure. Join us on the journey by learning more about our clinical trials, research, or joining our mailing list.