Feature articles

Is chronic heart failure preventable?

Congestive heart failure, or chronic heart failure as it is sometimes known, is a serious condition in which the heart becomes weak and loses the ability to pump blood around the body normally. [1–3] Not surprisingly, this can severely affect people’s ability to undertake normal daily activities, and can be fatal if the underlying causes are left untreated.

In most people, chronic heart failure is a lifelong condition that can only be treated and not cured. The best defense, therefore, is to control the underlying causes, and this article discusses the causes of chronic heart failure and outlines some of the steps that everyone can take to keep their heart strong and healthy. [4]

A multitude of causes

Chronic heart failure can be caused by anything that weakens or damages the heart and stops it from pumping normally. Most people who develop the condition have another medical disorder that affects the heart or blood vessels, such as:

• High blood pressure
  
• Heart attack
• Narrowing of the heart’s arteries (for example, coronary artery disease, angina)
  
• Diseased heart muscle
  
• Leaking or narrowing of heart valves
  
• Heart defects present at birth
  
• Abnormal heart rhythms
  
• Infections of the heart.

Chronic heart failure can also be caused by medical conditions and behaviors that weaken the heart muscle, such as:

• Diabetes
  
• Lung disease
  
• Anemia
  
• Underactive thyroid gland (hypothyroidism)
  
• Alcohol abuse
  
• Some medical treatments.
  
  

All of the above cannot only lead to the development of chronic heart failure, but they can also make the condition much worse once it has developed, making the heart progressively weaker.

Other risk factors

There are various other factors that do not directly cause chronic heart failure but can make the disease more likely to develop. These include:

• Smoking
  
• Being overweight or obese
  
• Having high blood cholesterol levels
  
• Being physically inactive.
  

Being overweight is a risk factor


While these risk factors can be modified to some degree (for example, by stopping smoking or exercising more), one risk factor, age, cannot. The risk of developing chronic heart failure increases with age, with the average age of diagnosis being at around 75 years. This increased risk is partly because the heart muscle becomes stiffer and less efficient as a natural consequence of aging, and partly because many of the common causes of chronic heart failure, including high blood pressure and heart attacks, increases from mid-life onwards.

Minimizing the risk

Chronic heart failure does not have a single cause, so there is no single way of preventing it. However, there are many ways in which people can reduce their risk of developing the condition.

Step 1
The first step is to learn about the causes of and risk factors for the condition, as mentioned earlier, and to know whether any of these affect you. Having high blood pressure is one of the most important factors, and it should be checked regularly, and at least once a year. Your doctor can tell you if you have any other risk factors.

Step 2
The second step is to treat the underlying causes and control the associated risk factors. Fortunately, many of the conditions that can cause chronic heart failure are easily treatable.

For instance, people with high blood pressure should try to lose excess weight, eat a healthy diet if they aren’t already, cut back on salt and alcohol intake, and take regular exercise. Medications may also be used to keep blood pressure under control.

Similarly, people with coronary artery disease, diabetes, or high blood cholesterol can all be effectively treated with medications and/or changes to their diet and lifestyle; and many abnormalities of the heart valves and rhythm can be corrected with surgery.

Step 3
The third step toward reducing the risk of chronic heart failure is to keep any predisposing conditions or risk factors under control. This means having regular medical checkups, following doctors’ advice, and taking all medications as prescribed.

By learning to recognize the factors that contribute to chronic heart failure and following doctors’ advice, the risk of developing chronic heart failure can be kept to a minimum.

Treating chronic heart failure

The goals of treating someone who already has chronic heart failure are different to those when treating someone who may be at high risk of developing the condition.

For someone with the condition, treatment aims to relieve symptoms and slow the progression of the disease. Heart failure cannot be reversed; however, its impact can be reduced by starting treatment as soon as possible after diagnosis and continuing it for life.

Chronic heart failure is usually treated with a combination of medications and lifestyle changes.

Non-drug treatments

Healthy lifestyle changes are useful for relieving symptoms, increasing the effectiveness of medications, and improving a person’s overall quality of life and sense of wellbeing. The central lifestyle issues to address are:

• Weight – maintain a healthy weight
  
• Diet – restrict salt and alcohol intake
  
• Smoking – if you smoke, stop
  
• Exercise – but always consult a doctor before starting any new exercise program

Drug treatments

The medications used to treat chronic heart failure have a range of benefits, from relieving symptoms and slowing the progress of the disease to preventing complications, hospital admissions, and death. The most common medications used for the condition are:

• Diuretics (often called “water pills”)
  
• Angiotensin converting enzyme (ACE) inhibitors
  
• Angiotensin receptor blockers (ARBs)
  
• Beta-blockers
  
• Aldosterone antagonists
  
• Digoxin
  

Often, several drugs are needed to achieve the greatest improvements. This may mean taking many different tablets every day. Although doctors have very good medical reasons for prescribing a number of different tablets, taking multiple medications can have its drawbacks – both practical and psychological. Furthermore, taking many different drugs can increase the likelihood of unwanted side effects.

If you are being treated for chronic heart failure you should make sure that your doctor reviews your medications regularly; he or she should assess that:

• All drugs are being taken exactly as instructed
  
• The medication are controlling your symptoms
  
• That you have not developed any new symptoms or side effects
  
• If any of your medications be changed or stopped
  

The main message, therefore, is that although chronic heart failure cannot always be prevented, everyone can decrease their chances of developing the disorder by being aware of the causes and risk factors and controlling these where necessary.

Meanwhile, people who have already developed the condition should be encouraged by the fact that the right treatment can slow the progression of the disease, improve symptoms, and enable them to lead full and active lives.

References

1. Congestive Heart Failure. American Heart Association. Accessed 23 January, 2007. 
   
2.  What Is Heart Failure? National Heart, Lung, and Blood Institute. Accessed 23 January, 2007. 
   
3. What is Heart Failure? Patient Health International. Accessed 23 January, 2007.
   
4. Heart Health. British Heart Foundation. Accessed 23 January, 2007