Nikita Monteiro

Over 17.5 million lives around the world are lost every year due to heart failure. India serves as the home for over 40% of the world’s heart failure patients. The number of people affected by cardiac diseases is on the rise, having doubled between 1990 and 2016. But the failure of the heart doesn’t mean a complete stoppage of the heart. It is a term loosely used to describe the inability of a heart to deliver on its workload, which then deprives the body of the oxygen that it desperately needs.

It’s all in the diagnoses 

Almost 50% of patients that have heart conditions of any form can be misdiagnosed. If it sounds bad, that’s mostly because of the methods being used to identify heart disease, such as medical history, and clinical assessments, are being used. With symptoms of heart disease being hard to detect, any potential misdiagnosis can add to the patient burden, while also increasing healthcare costs associated with their treatment. Further testing can help with ensuring optimal patient management and should definitely be recommended to confirm an initial diagnosis. 

Initial diagnosis based on medical history and a clinical assessment and backed up with an ECG (electrocardiogram), a test for biomarkers (natriuretic peptides) and echocardiography to check for functional and structural impairments such as changes in wall stress and wall thickness, heartbeat rhythm, and pumping capacity, can help confirm the diagnosis of heart failure. 

Complicating heart failure – comorbidities

Comorbidities that may be cardiovascular or non-cardiovascular in nature, can both be commonly observed in patients with heart failure. They may incite heart failure, complicate diagnosis and make symptoms more difficult to treat. This is a cause for concern for many reasons. In people above the age of 65 with the disease, nearly 5 or more comorbidities can be seen in over 40% of the sufferers. It also accounts for 81% of the total days they spend in the hospital. A third of heart failure patients also typically have chronic obstructive pulmonary disease. Over 40% have diabetes mellitus and an increased risk of morbidity and mortality when the conditions overlap. In fact, diabetes mellitus and it have a bi-directional relationship, with the disease being a potential cause for left ventricular dysfunction, and heart failure directly increasing the risk of diabetes. Other commonly seen comorbidities such as thyroid disorders, iron deficiency, depression, obesity, and sleep-disordered breathing, particularly in elderly patients can make treatment and diagnosis difficult. 

Pioneering the need for a national heart failure registry

Since 2013, over 1205 patients from 18 different hospitals suffering from heart disease have provided data that drives and leads discussion on the failure of the heart even today. The Trivandrum Heart Failure Registry has collected data on demographics, treatment, clinical presentation, and outcomes. Through multiple rigorous analyses, it was found that participants have a high three-year all-cause mortality. The data also showed that ischemic heart disease tops the list in the country and that the mortality rate is high when compared to that of cancer. 

Is there a way out? Can heart failure be reversed?

Improving the quality of life after one's heart fails isn’t easy, but with cardiac rehabilitation, quality and length of life can definitely be improved. Cardiac rehabilitation includes education on heart-healthy living, exercise training, and even counseling to reduce stress levels. Through this focused form of rehabilitation, the physical, mental and social function can slowly be enhanced. These programs focus on identifying needs and limitations, tailoring a program to suit those needs, and counseling and education to help patients understand the condition they have. Through support and training, modification of risk factors through diet and nutrition, and optimal use of medication cardiac rehabilitation can help enhance the quality of life.