Congestive Heart Failure: Seniors, Statistics and Stories
Congestive heart failure, often simply called heart failure, comes to people by many routes. Heart failure refers to the heart muscle's inability to pump blood to meet the body's need. Oftentimes, heart failure is a complication of chronic diseases that people are more likely to accumulate with age.
Diabetes, high blood pressure, emphysema and other conditions can all cause heart failure. The symptoms of heart failure include fatigue, coughing, shortness of breath, abdominal, leg and ankle swelling, heart palpitations and sudden, significant weight gain -- all of which can drastically affect people's quality of life.
Heart failure can be an aftereffect of a heart attack or stem from heart disease such as cardiomyopathy, coronary artery disease, valve disease or arrhythmia. It can also result from congenital heart defects that kids are born with. Cancer treatments such as chemotherapy and radiation may sometimes contribute.
[See: 11 Questions You Should Ask Your Cardiologist During Your First Visit.]
The impact of heart failure varies widely from state to state, and within states. In the worst-affected areas of Texas, the heart failure death rate for adults 35 and older exceeded 200 deaths per 100,000 people from 2014 to 2016, according to the Centers for Disease Control and Prevention. In Arizona, by contrast, death rates ranged somewhere between 48 and 165 per 100,000 people in that same age group.
Race is another factor in heart failure. Black people have about 1.5 times the risk of having heart failure as white people, according to American Heart Association figures.
As daunting as heart failure sounds -- starting with its discouraging name -- people with heart failure can manage well with early detection and proper treatment. Below, a cardiology expert describes the main types of heart failure and therapies, and patients describe what it's like to live with heart failure daily.
Life With Heart Failure
Donnette Smith, 72, of Huntsville, Alabama, sits in her cardiologist's exam room waiting to be seen. It's a routine checkup -- nothing new for Smith, who comes in every three months or so for the heart failure she's had since her 30s. Through the years, Smith has dealt with multiple medical conditions and been through numerous heart procedures. Yet she's doing well, staying on top of her symptoms and taking a positive stance.
Congestive heart failure has taken a toll on Smith and on her family. She keeps a close eye on her 92-year-old mother, who developed heart failure later in life. That was after suffering two heart attacks while she was in a rehab facility recovering from a hip replacement. "We're managing her heart failure really well," Smith says.
Pushing back at heart failure keeps Smith busy. She's the past president of Mended Hearts, a nonprofit group focused on heart-disease patients, and now heads the board for Heart Valve Voice US. She travels extensively in her work to educate and help others with heart failure and related conditions.
Inspiration comes to Smith in large part from the tragic loss of her sister. "My youngest sister at age 33 was diagnosed with breast cancer," Smith says. "She had bilateral mastectomies and had chemotherapy. Ten years later, when she thought she was totally cured from the cancer, she started gaining a lot of weight and she was short of breath." Her sister, who'd had childhood asthma, believed she was having an asthma recurrence, but that wasn't the case.
"It turned out she had damage from the chemotherapy to her heart," Smith says. "She was in congestive heart failure and she was so bloated from the fluid that she had collected that she passed away. So I'm really tuned in to heart failure and what it's capable of doing to the body."
Heart Failure Types and Treatments
About 6 million adults in the U.S. have heart failure, according to the CDC. Older adults are hardest hit. "Heart failure is the most frequent reason for hospitalizations in adults who are 65 years or older," says Dr. Paulino Alvarez, a heart failure cardiologist and clinical assistant professor with University of Iowa Hospitals and Clinics.
Age, hypertension, diabetes mellitus and metabolic syndrome -- a cluster of symptoms including high blood pressure, low levels of (good) HDL cholesterol, high blood glucose and a large waist size -- all increase heart failure risk, and many chronic conditions can contribute to people developing heart failure, Alvarez emphasizes.
In a way, Alvarez says, increasing prevalence of heart failure is a testament to medical progress: With advances in medical therapies, patients are now living longer with once-lethal conditions and so more are likely to eventually develop heart failure.
[See: 10 Heart Health Breakthroughs.]
"The main thing with heart failure is, first, to be diagnosed correctly and exclude potentially reversible causes of heart dysfunction, for example, valvular disease, heart rhythm or coronary artery disease," Alvarez says. Once heart failure is established, he says, the next step is identifying which type a patient has. Heart failure with preserved ejection fraction and heart failure with reduced ejection fraction are the two broad categories.
"Ejection fraction is a measure of how well your pump function is, in terms of ability to pump blood," Alvarez explains. "In those patients with preserved ejection fraction, one of the main factors is the capacity of the heart to relax." If the heart can't relax properly with each beat, patients build up fluid and have shortness of breath.
Heart failure with preserved ejection fraction is the most common type of heart failure in the elderly, affecting more than 2 million Americans, according to a review article co-authored by Alvarez and published in the May 2019 Journal of Geriatric Cardiology.
"When you look at the echocardiogram, you see that the heart is squeezing OK, but it's not relaxing fine," Alvarez says. With these patients, he says, treatment is focused on closely controlling symptoms and underlying conditions. If patients suffer from fluid overload, diuretic medications (like Lasix) are used to keep the fluid at bay.
With reduced ejection fraction, the heart's pumping function has decreased. The body no longer receives the amount of oxygen-rich blood that it needs. Medications called ACE inhibitors, given along with beta blockers, are standard treatments for patients with low ejection fractions to reduce disease progression and ease the workload of the heart. A combination of blood pressure medications, hydralazine plus nitrate therapy, has been shown to help certain people with heart failure. All patients with heart failure are encouraged to follow a low-sodium diet.
In some cases, implanted devices such as pacemakers, defibrillators or mechanical pumps are needed, and heart transplant becomes a consideration.
"For select patients, devices like defibrillators and pacemakers are shown to decrease mortality," Alvarez says. Some patients with advanced heart disease benefit from having a surgically implanted, mechanical pump called a left ventricular assist device. In some cases, the LVAD is considered a bridge to a transplant for people waiting for a donor heart.
A team approach including psychologists, social workers, pharmacists, nutritionists and others is important for heart failure patients, Alvarez says. Patients who develop depression may benefit from counseling, he adds. Family support is essential, as well, to help patients have the best quality of life possible. "That's our main objective," he says.
Smith has heart failure with preserved ejection fraction. "I'm able to manage mine with diuretics and diet, staying off salt and getting exercise," she says. She feels fortunate to have a "really great" doctor working with her. Of course, her condition and treatment present challenges.
"I travel a lot," Smith says. "So it's hard to take a diuretic in the morning when you're getting on an airplane and going to be flying. You can't just get up at any time and go to the bathroom. But when you take a diuretic, you gotta go when you gotta go." Unfortunately, she says, people may stop taking diuretics because of the inconvenience. "That's something they need to discuss with their doctor," she adds.
Following a low-salt diet isn't too difficult at home, says Smith, whose husband also needs to do so because of kidney disease. When going out to eat, however, it's sometimes hard to find places willing to make dishes without adding extra salt.
Exercise is essential for people with heart failure. "Walking is the best exercise," Smith says. "It doesn't cost a thing, other than a pair of shoes." She's also been through cardiac rehab, which is a structured, medically supervised program to help heart patients become physically active. "It really helps," she says. "When I had my last surgery, I couldn't even walk without my husband supporting me. By the end of my time at cardiac rehab, I was running."
[See: Best Exercises for Heart Disease Patients.]
Positive Attitude
Regina Rexrode, 51, a website and graphic designer in Noblesville, Indiana, is another example of someone who hasn't let heart failure keep her down.
Rexrode was diagnosed with heart failure and two types of arrhythmia in 2006, as a complication of several heart conditions that began at birth and led to open-heart surgery by second grade. She described her experience, including having a pacemaker-cardioverter defibrillator implanted in her chest, in a March 2015 U.S. News story. Twice, she's had to be "drained" -- that is, undergo a procedure called paracentesis to remove excess fluid from her abdomen.
Today, Rexrode continues to cope. She transitioned from her previous career as an elementary school technology instructor to her current role, which allows her to work from home and rest when she really needs to, although it goes against her habits. "I'm not a rester," she says.
Rexrode hardly notices her implanted heart device. "I'm in chronic AFib all the time," she says. "I've just gotten used to that. And of course, they've got me on the right medicine to regulate my heart rate." Her family continues to provide support. "Basically, I can do anything I want," she says. "But if I get tired, they're going to accept that and walk with me instead of running."
Like Smith, Rexrode reaches out to others with heart conditions. Her candid piece on the challenges of a low-sodium diet was published in the May 2018 issue of the journal JACC: Heart Failure, and she blogs about her medical journey. She serves on the patient and family advisory council for St. Vincent Heart Center of Indiana, but jokes that she's happy to avoid being admitted as an inpatient.
With their positive attitudes, the term "heart failure" doesn't really seem to apply to Rexrode or Smith. And it's a term the latter could well do without.
"I wish they would change it to something else," Smith says. "It sounds like your heart's failing, kind of like your engine died in your car -- and it's really not the case. It can be managed and managed well, if you just stay on top of it."
