Heart Failure Part 2: Who Is Most at Risk For Heart Failure?

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In this second part of a two-part series on heart failure (read the first part for more info on what it is and symptoms), we explore who is most at risk and new heart failure treatment options to improve quality of life with the director of the Women’s Heart Failure Clinic at the Cleveland Clinic and chair of the WomenHeart Scientific Advisory Council, Eileen Hsich, M.D.

Lisa Nelson, R.D.: Who is most at risk for heart failure?

Dr. Hsich: The people who are most at risk are people who have had heart attacks. That is the most common risk factor, for both men and women. Once you’ve had a heart attack, you’re at the highest risk to have heart failure. High blood pressure is more common in women than men as the cause. So is valvular disease. Diabetes is a common risk factor for both women and men.

Lisa: How about in regards to age or race? Is there any predominance in one group versus another?

Dr. Hsich: Yes. Women are more likely than men to develop heart failure due to high blood pressure and valvular disease, and develop it at older ages, as well as with stronger hearts. Men tend to develop heart failure with weaker hearts, younger ages, and due to heart attack.

Patients who are African American often have high blood pressure as the underlying cause. They can develop heart failure with a weak heart or a strong heart. High blood pressure is often the underlying cause. I always refer to it as the silent killer. None of us can feel our blood pressure. It’s really important that we get checked. Diabetes is also something that you don’t necessarily know until you get checked.

Lisa: What advice do you have for patients when they approach their doctor about any new options available for managing heart failure?

Dr. Hsich: We have medical guidelines that tell us what we should be doing. What’s exciting about this particular time is that, for a long time, we didn’t have any new drugs. We now have two drugs that have been FDA-approved for heart failure and incorporated into our guidelines.

Both of these medications reduce hospitalizations for heart failure. One of them is a medication that reduces heart rate. The other one reduces blood pressure. The combination pill that reduces blood pressure also prevents death due to heart disease. These are exciting times. You should ask your doctor or medical provider which drugs are best for you. Not everything is right for everyone. We do have wonderful new therapy out there.

Lisa: What should we know in regards to lifestyle choices and heart failure?

Dr. Hsich: For all heart disease, it’s important that we take care of ourselves. We don’t smoke. We exercise. Exercise can reduce blood pressure as well as help us lose weight. It can affect our cholesterol. It’s important that we also eat right, that we try to avoid fatty foods and salt. Salt can raise blood pressure in some people. If you have heart failure, salt can cause you to have fluid retention and become more short of breath.

Lisa: What is a typical prognosis for someone diagnosed with heart failure? Now, you said it’s generally good, with one out of four recovering fully.

Dr. Hsich: Yes, one out of four will recover fully based on an IMAC study. It was a study done to assess patients who were just diagnosed with heart failure. One out of every four fully recover. Most patients do improve on medical therapy. They feel better, which is also important.

I think the reason why people get depressed is that they feel horrible. If you feel lousy every morning when you wake up, you’re not going to be very hopeful about your future. I think that it’s really important to also realize that, by taking medication, you’re going to feel better.

You also shouldn’t feel alone. We do have support groups out there. I’m part of a group that I’m very proud of. It is called WomenHeart. It’s a patient advocacy group that was formed by women who had heart disease. This website — womenheart.org — provides educational material. It also has the ability to provide emotional support through peer groups, one-on-one, as well as telephone and online communication.

If you are diagnosed with heart failure, whether you are a man or a woman, you should seek medical attention because of the fact that there are new drugs out there. They have helped patients feel better as well as live longer. WomenHeart.org can help provide the emotional support that they need. This support group is specific to women with heart disease. That’s what makes it more unique. Cleveland Clinic also has a website for patients with heart disease. For the men out there, I would use that as their educational source. It is ClevelandClinic.org.