Why patients are being
diagnosed with heart failure
at 50 years old and what you
can do to lower your risk
One in five people worldwide run the risk of developing congestive heart failure, and this prevalence increases with age. At its base, congestive heart failure implies that your heart, which is a pump, cannot adequately provide the circulatory support required to maintain profusion to all of your organs. As there is no cure for the ailment, patients can only monitor their health closely with lifestyle changes or medication to prevent their heart function from deteriorating irreversibly.
On top of their being no cure for congestive heart failure, the condition is one of the most common infirmities affecting adults over 40 years old with more than 200,000 cases being diagnosed in the US every year. “Unfortunately what we are seeing more common these days are patients in their 50’s and 60’s with congestive heart failure,” states Dr. Connor Healey, a board-certified cardiologist with Capital Cardiology Associates. And for younger patients who receive the diagnosis, “The real scary thing is the overall expected lifespan is five years.”
Some people present no congestive heart failure symptoms. For others, they can experience shortness of breath when doing a light activity like walking around the supermarket, dizziness, fatigue, fluid retention (causing swelling in the lower extremities), sudden weight gain, and changes in their heartbeat. To diagnosis congestive heart failure your doctor will order a series of tests beginning with a blood test, echocardiogram, electrocardiogram x-rays, CT scan, stress test — all designed to show your heart’s function.
“The problem with congestive heart failure is that it covers such a wide swath of sub diseases,” states Dr. Healey. While you can’t prevent heart disease, for young adults looking to minimize their risk of developing heart attack, stroke, and heart disease that means avoiding lifestyle choices like excessive alcohol use, cigarette smoking, poor dieting, minimal to little physical activity/exercise, and poor sleeping habits. “The heart is an organ; it can’t live forever, it will exhibit age-related changes in your life,” he says. You should also have a regular conversation with your primary care provider, who can map out an individual assessment of risk and prevention plan. “The best thing you can do is to avoid getting congestive heart disease in the first place.”
Types of Congestive Heart Failure
Congestive heart failure is traditionally into two different aspects: systolic and diastolic.
Systolic congestive heart failure implies that the pumping of the heart is weak. As Dr. Healey explains, “We refer to that by the injection fraction which is a useful piece of information for patients to know and to ask their doctor, ‘What is my ejection fraction?'” Ejection fraction (EF) refers to how much blood in the heart, per pump, exits the heart and travels through the body. Most times, EF refers to the amount of blood being pumped out of the left ventricle, the heart’s main pumping chamber, each time it contracts.
Ejection fraction is expressed as a percentage. “A normal value is between 55 and 70%,” says Dr. Healey. “That might not be a great score on an exam but for an EF that is pretty good. Anything less around 40-50% is systolic congestive heart failure.” Your EF can go up and down, based on your heart condition and how well your treatment works.
The other group is diastolic heart failure which means the lower left chamber of the heart (left ventricle) is not able to fill correctly with blood during the diastolic phase, reducing the amount of blood pumped out to the body. “This is a normal EF, but the heart doesn’t function quite as well because it is stiff,” notes Dr. Healey. Over time, this causes blood to build up inside the left atrium, and then in the lungs, leading to lymphatic congestion and symptoms of heart failure. “This is generally related to inflammation and fibrosis which can be caused by any number of factors.”
The American College of Cardiology along with the American Heart Association have collaborated to categorize the four stages of heart failure (HF).
The American Heart Association describes Stage A as, “At high risk for HF but without structural heart disease or symptoms of HF.” This diagnosis is typically for patients with hypertension, diabetes, or obesity. “If you have risk factors without actually congestive heart failure, we still label you as Stage A because we want you to be aware of how serious this diagnosis is and to prevent you from progressing to that next stage which is having congestive heart failure,” said Dr. Healey. The risk factors for Stage A include atrial fibrillation (A-Fib), hypertension, coronary artery disease (which involves diet, cholesterol, exercise), and sleep apnea. “AFib is a big risk for diastolic congestive heart failure because if you have a stiff heart, and now you are losing the coordination that occurs with AFib, now you have an inefficient heart with chambers squeezing at inappropriate times, leaving the remaining chambers to try to pick up the slack.”
Your doctor will talk with you about embracing a heart-healthy lifestyle as part of our treatment goals and may prescribe medications (like a statin) to treat vascular disease, diabetes, or high cholesterol.
Stage B is outlined as, “Structural heart disease but without signs or symptoms of HF.” Most people with Stage B heart failure have an echocardiogram (echo) that shows an ejection fraction (EF) of 40% or less. “We’ve made the diagnosis after an ultra-sound of your heart which is generally the way we make the diagnosis along with clinical symptoms,” describes Dr. Healey. “You have parameters that suggest your heart is not functioning properly; it’s either weak or inefficient. Again, you’re not symptomatic, so we have time to intervene before it becomes a point where it’s affecting your life.”
Patients diagnosed with Stage C have heart failure. “Stage C is the bulk of patients which is symptomatic,” commented Dr. Healey. They will be prescribed many medications to relieve their symptoms. They are placed on low sodium diets. They could also have pacemakers implanted or be put on implantable cardiac defibrillator (ICD) therapy.
“Stage D is the end stage of heart failure,” begins Dr. Healey. “Typically that’s systolic congestive heart failure where your pump is completely inadequate. Essentially, you cannot get up and walk more than 20 feet without getting a significant shortage of breath where you have to stop.” Treatment options at this stage include heart transplant, surgery, and research therapies.
Watching Your Weight
A report published in November of 2018 examined a patient’s risk of heart disease compared to their weight history. From the age of 20-40, participants had their weight and body mass index (BMI) score recorded. The team found a 34% increased likelihood of heart disease for every 5 BMI points. “Weight has such a negative impact on many cardiac functions. Most notably I would say, congestive heart failure,” said Dr. Healey. The study authors concluded that “control of BMI throughout the lifetime is important for reducing the risk of heart failure.”
This is why patients are weighed at the beginning of every appointment or office visit. “If we start seeing 5, 10-pound weight gains between visits, that’s something we need to address.” In the weight history study, the authors noted that “the prevalence of obesity in the United States is strikingly high, seen in 36% of adults.” Experts link obesity as a warning sign for younger generations and a contributor to early heart disease diagnosis. “I think as Westerners, in general, we have become accustomed to living at this higher weight, that we think it’s a commonplace, that’s how the body is supposed to be. Well, no, that’s not the case. We need to reverse the attitudes we have about diet, weight, and healthy living,” said Dr. Healey.
“The goal is that patient’s come in for wellness visits. To talk with them about their lives and all of the wonderful things that they are doing. Helping them minimize medications, then the flip side, seeing them after the hospital visit after they’ve been in for congestive heart failure, after a heart attack, and now we are trying to play catch up.”
Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.