Heart failure is the most rapidly rising cardiovascular disease, and currently affects over half a million Canadians. According to Heart and Stroke Foundation statistics, about 50,000 Canadians are added to that list every year. At the latest Sunnybrook Speaker Series, entitled Go With the Flow: Keeping Well With the Schulich Heart Team, Dr. Stephanie Poon talked about the progress being made in treating this prevalent condition.
Heart failure is a growing epidemic that carries a heavy cost to patients, their families and the health care system, says Dr. Poon, cardiologist and medical co-director of the Heart Function and Rapid Cardiology Assessment Clinic. The average life expectancy after being diagnosed is about five years. It’s also a big reason people are admitted and readmitted to hospital.
Heart failure is a gradual decline in the heart’s ability to pump and circulate blood, which occurs when the heart muscle becomes damaged, she says. Some of the common causes of heart failure include:
- heart attack
- chronic high blood pressure
- a viral infection of the heart
- valvular disease (a defect in one of the four heart valves)
- alcoholism or other toxins (i.e. chemotherapy, cocaine)
- congenital conditions
There are two types of heart failure. In systolic heart failure, the heart becomes dilated and weak and doesn’t pump blood properly. In diastolic heart failure, the heart is stiff and has trouble relaxing. That can cause the left ventricle to fill with blood and move it backward, resulting in lung congestion and shortness of breath. Other symptoms include cough and swelling in the abdomen, legs and feet.
There are a number of medications to treat heart failure, says Dr. Poon. Diuretics, or water pills, help to decrease the fluid buildup in the body. Beta-blockers work to slow the heart rate down, lessening stress on the heart. Angiotensin-converting enzyme (ACE) inhibitors open up the blood vessels to improve blood flow. And aldosterone antagonists reduce salt and water retention. Newer medications are also now being used, like ivabradine, which slows down heart rate without decreasing blood pressure. Research has shown that a lower resting heart rate will decrease the risk of dying, so one important goal of treatment is keeping the resting heart rate at 50-60 beats per minute, or as low as can be tolerated. Dr. Poon says it’s important for each patient to determine with their health care provider the best medication and dose.
About ten percent of Canadians with heart failure have advanced disease, causing severe symptoms that affect overall quality of life. Dr. Poon says there are devices, like the left ventricular assist device (LVAD) that can be implanted to help the heart pump blood to the rest of the body. In some cases, this device can be used to help patients who are waiting for a heart transplant or may become candidates for one.
Despite the growing prevalence of heart disease in Canada, Dr. Poon says there is a lot to be hopeful about. “We have medications that will help you live longer, keep you out of hospital and make your heart stronger. Medical therapy works and I see evidence of this every single day. And if medications are not enough, there are other options.”
Watch the archived webcast of this Speaker Series event: