Congestive heart failure

• What is Congestive Heart Failure
• Statistics on Congestive Heart Failure
• Risk Factors for Congestive Heart Failure
• Progression of Congestive Heart Failure
• Symptoms of Congestive Heart Failure
• Clinical Examination of Congestive Heart Failure
• How is Congestive Heart Failure Diagnosed?
• Prognosis of Congestive Heart Failure
• How is Congestive Heart Failure Treated?
• Congestive Heart Failure References

What is Congestive Heart Failure

Congestive heart failure, in simple terms, is when the heart fails to maintain an adequate circulation of blood around the body owing to a defect in the heart’s pumping action.

Statistics on Congestive Heart Failure

Congestive heart failure estimated at least 300,000 Australians currently suffer Congestive heart failure (CHF) and around 30,000 new cases are diagnosed each year;

• Heart failure is generally a disease affecting the older generation – 13 per cent of people aged 65 and over presenting to a GP suffer heart failure;
• In 1996 and 1997, 41,000 hospitalisations reported congestive heart failure as a principal diagnosis;
• During 1996 and 1997 congestive heart failure contributed to 2 per cent of all deaths;
• Congestive heart failure has been estimated to account for $411 million of the total direct health costs attributed to cardiovascular disease. This figure for CHF includes $140 million per year on hospitalisation and $135 million per year on nursing home costs;

Congestive heart failure is the only major cardiovascular disease that still has an increasing incidence and prevalence, and the number of cases of heart failure in regions worldwide reflects this:

• The statistics of Congestive heart failure is estimated to be as many as 20 individuals per 1,000, rising to as many as 130 individuals per 1,000 for those aged over 65 years;
• In Western Europe there are over five million congestive heart failure patients, whilst in the USA there are around five million heart failure sufferers, with 400,000 new cases of congestive heart failure diagnosed each year;
• The number of new cases of heart failure reported in Europe every year is approximately two to three per 1,000;
• Worldwide among the 70-80 age group, one hundred people per 1,000 have heart failure.

The incidence and prevalence of heart failure is still rising and it is predicted that this will continue. There are two main reasons for this increase:
1) Advances of modern medicine:
The improved management of cardiovascular disease means that patients now survive longer. Many patients who have heart attacks are now surviving them because of modern medical treatment and more rapid response times from medical services. However, the heart muscle of these patients is often damaged and can no longer compensate, leading to the development of heart failure. This has been described as an “ironic failure of success”.
2) Ageing of the population:
Older people have a much higher prevalence of heart failure than younger individuals, which may be due to the greater frequency of common risk factors for heart failure, such as hypertension, myocardial infarction (heart attack) and diabetes mellitus. Among those aged over 80 years, the prevalence of heart failure reaches one in ten. In Europe, the average age of the population in 1950 was 29.2 years however by 1998 this had risen to 37.1 years. By 2050, the average age of the population is predicted to reach 47.7 years, leading to a higher incidence of heart failure.

Risk Factors for Congestive Heart Failure

• Infection.
• Anaemia.
• Thyrotoxicosis.
• Pregnancy: Women with rheumatic valvular disease can first experience symptoms during pregnancy and following delivery of the baby these symptoms may be resolved.
• Abnormal heart rhythms.
• Rheumatic fever.
• Infective endocarditis and Myocarditis.
• Hypertension (High Blood Pressure).
• Heart attack.
• Myocardial infarction.
• Pulmonary embolism.
• Overexercise.
• Sudden increase in salt in the diet.
• Excessive environmental heat or humidity.
• Emotional crises.

Progression of Congestive Heart Failure

Congestive heart failure can occur when the heart has been overworked or damaged in some way. High blood pressure over many years, heart valve disease, defects in the heart at birth and infection are some of the causes.
The most common cause is a heart attack – also known as myocardial infarction or “coronary”. Heart failure can result from one large heart attack or several smaller ones. Another common cause is a disease of the heart muscle known as cardiomyopathy. This can be caused a viral infection or excess alcohol consumption on a regular basis.
The cost and burden of congestive heart failure is expected to increase markedly due to a number of factors:

• The ageing population;
• The projected increase in the number of older people with coronary heart disease and hypertension;
• The decrease in fatality rates associated with acute coronary disease;
• Improved diagnosis of CHF because of the increased use of sensitive techniques such as echocardiography.

How is Congestive Heart Failure Diagnosed?

• Full blood count.
• Urea and electrolytes.
• Thyroid function tests.
• Electrocardiography.
• Chest x-ray.
• Pulse oximetry.

Prognosis of Congestive Heart Failure

Congestive heart failure is usually a chronic illness, and it may worsen with infection or other physical stressors. But with medication and correction of underlying disorders, it can be controlled.

How is Congestive Heart Failure Treated?

A variety of congestive heart failure medications are used to treat congestive heart failure in order to reduce the work the heart has to do, relieve symptoms and reduce the build-up of fluid:-

• Diuretics or fluid tablets work on the kidney to remove excess fluid from the body.
• ACE inhibitors relax blood vessels making it easier for the heart to pump blood to all tissues of the body.
• Digoxin helps the heart beat more strongly, slowly and regularly.
• Spironolactone is used in moderate and severe heart failure to reduce the impact of hormones on the heart and prevent scarring.

Congestive Heart Failure References

1. Albanese MC, Plewka M et al. Use of medical resources and quality of life of patients with chronic heart failure: A prospective survey in a large Italian community hospital. European Journal of Heart Failure. 1999; 1(4): 411-417.
2. American Heart Association statistical database: Economic cost of cardiovascular disease, 1999.
3. Beamish RE. Heart failure: the ironic failure of success. Canadian Journal of Cardiology. 10, 603 (1994).
4. Cowie MR, Mosterd A et al. The epidemiology of heart failure. European Heart Journal 1997; 18: 208 -225.
5. Dominguez, L.J., Parrinello, G., Amato, P. & Licata, G. Trends of congestive heart failure epidemiology: contrast with clinical trial results. Cardiologia 1999; 44: 801-808.
6. Guidelines for the contemporary management of the patient with chronic heart failure in Australia. National Heart Foundation of Australia and the Cardiac Society of Australia. www.heartfoundation.com.au
7. Kannel WB, Belanger AJ. Epidemiology of heart failure. American heart Journal. 1991; 121: 1042-7.
8. Krum H, Tonkin AM, Currie R, et al. Frequency, awareness and pharmacological management of chronic heart failure in Australian general practice. The Cardiac Awareness Survey and Evaluation (Case) Study. Med J Aust 2001; 174: 439-444.
9. Linne AB, Liedholm H et al. Health care costs of heart failure: Results from a randomised study of patient education. European Journal of Heart Failure. 2000; 2(3): 291-97.
10. McMurray JJ, Stewart S. Heart failure – epidemiology, aetiology, and prognosis of heart failure. Heart 2000; 83: 596-602.
11. O’Connell JB. The Economic Burden of Herat Failure. Clinical Cardiology 2000. Vol 23 Sup 3: 6 – 10.
12. Stewart S, Jenkins A, Buchan S, S Capewell, McGuire A, J J V McMurray. The current cost of Heart failure in the UK – an economic analysis. Eur J Heart Failure, 2002;4:361-71.
13. Stewart S et al. The current cost of heart failure to the National Health Service in the UK, European Journal of Heart Failure 2002; 4 (3) 361-371.
14. Swedberg K, Rosengren A, Schaufelberger M et al. Presentation at ACC Annual Meeting 2003.
15. United Nations Population Division, World Population Prospects: The 2002 Revision and World Urbanisation Prospects: The 2001 Revision.
16. Wolinsky FC. The risk of hospitalisation for congestive heart failure among older adults. Med Care 1997; 35, 1031-1043.