Heart Failure

Page 1 2 3

What is Heart Failure?

3D Animation on
Congestive Heart Failure

This animation brought to you by Blausen Medical Communications.
Contact Andrew Walbank.

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. Heart disease can lead to heart failure.

Who gets Heart Failure?

It is estimated at least 300,000 Australians currently suffer heart failure and around 30,000 new cases of heart failure are diagnosed each year:

Heart failure is generally a disease affecting the older generation: 13% of people aged 65 and over see their GP for heart failure.
In 1996 and 1997, 41,000 hospitalisations reported heart failure as a principal diagnosis.
During 1996 and 1997, heart failure contributed to 2% of all deaths;
Heart failure is estimated to account for $411 million of the total direct health costs attributed to cardiovascular disease (estimated in 1993-94 at $3,719 million). This figure for heart failure includes $140 million per year on hospitalisation and $135 million per year on nursing home costs.

Heart failure is the only major cardiovascular disease that still has an increasing number of cases in regions worldwide:

20 per 1,000 people have heart failure, rising to as many as 130 per 1,000 for those aged over 65 years.
In Western Europe there are over five million heart failure patients.
2-3 new cases of heart failure per 1,000 people are reported in Europe every year.
In the USA there are around five million heart failure sufferers, with 400,000 new cases diagnosed each year.
Worldwide among the 70-80 age group, 100 in every 1,000 people 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.

Advances of modern medicine

Improved management of cardiovascular disease means that patients survive longer. Many patients who have heart attacks now survive because of modern medical treatment and faster response times from medical services. However, the heart muscles of these patients are often damaged and can no longer compensate, leading to the development of heart failure. This has been described as an "ironic failure of success".

Ageing of the population

More older people have heart failure than younger people, which may be due to the greater frequency of common risk factors for heart failure (e.g. high blood pressure, heart attack and diabetes mellitus. One in ten people over 80 years old have heart failure. In Europe, the average age of the population in 1950 was 29.2 years; 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 yet higher rates of heart failure.

Virtual Medical Centre Video

Watch a video on Cardiovascular Disease Prevention

Predisposing Factors

Infection
Anaemia
Thyrotoxicosis
Pregnancy:Women with rheumatic valvular disease can first experience symptoms during pregnancy; following delivery of the baby, these symptoms may be resolved.
Abnormal heart rhythms
Rheumatic fever
Infective endocarditis and myocarditis
High blood pressure
Heart attack
Pulmonary embolism
Over-exercise
Sudden increase in salt in the diet
Excessive environmental heat or humidity
Emotional crises

General Cardiovascular Disease 10-Year Risk Calculator

This risk assessment tool is based on data from the Framingham Heart Study to estimate 10-year risk for general cardiovascular disease outcomes (coronary death, myocardial infarction, coronary insufficiency, angina, ischaemic stroke, haemorrhagic stroke, transient ischaemic attack, peripheral artery disease, heart failure). This tool is designed to estimate risk in adults aged 30-74 years of age without CVD at baseline examination. Use the calculator below to estimate 10-year risk.

Predictors

Age		years
		Male	Female
Gender
		Yes	No
Have you been diagnosed with Type II diabetes?
Are you a smoker?^*
Are you prescribed medication to lower your blood pressure?

If you do not know the following blood pressure and cholesterol parameters ask your General Practitioner on your next visit.
Systolic blood pressure^**		mmHg

Total cholesterol^***	mmol/L OR	mg/dl

HDL cholesterol^****	mmol/L OR	mg/dl

Results

Significant (> 20%)
Elevated (10–20%)
Mild risk (< 10%)
You have a significant risk of future cardiovascular disease requiring aggressive risk factor modification. You should see a health professional to ensure appropriate management.

If diabetic, your sugar levels should be well controlled.
Continue to avoid tobacco use or if you are a smoker, consider stopping this is something your General Practitioner can help you with.
Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.
Cholesterol levels should be assessed at least annually. Depending on your level, you might be advised to commence lifestyle changes or medication.

Significant (> 20%)
Elevated (10–20%)
Mild risk (< 10%)
You have an elevated risk of future cardiovascular disease requiring risk factor modification. You should see a health professional to ensure appropriate management.

If diabetic, you should aim for your sugar levels to be well controlled.
Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.
Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.
Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.

Significant (> 20%)
Elevated (10–20%)
Mild risk (< 10%)
You have a mild risk of future cardiovascular disease, consider risk factor modification. You may like to see a health professional to ensure appropriate management.

If diabetic, you should aim for your sugar levels to be well controlled.
Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.
Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.
Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.

^*For these purposes "smoker" means any cigarette smoking in the past month.
^**Use current blood pressure, regardless of whether the person is on antihypertensive therapy.
^***Total cholesterol values should be the average of at least two measurements obtained from lipoprotein analysis.
^****HDL cholesterol values should be the average of at least two measurements obtained from lipoprotein analysis.

References:

D'Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117: 743-753.
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 31433421.
Stancoven A, McGuire DK. Preventing macrovascular complications in Type 2 Diabetes Mellitus: glucose control and beyond. American Journal of Cardiology 2007; 99: 5H-11H.

This tool needs javascript enabled to work.Male risk estimate

Points

Age

HDL

Total Cholesterol

SBP Not Treated

SBP Treated

Smoker

Diabetic

-2

60+

<120

-1

50-59

30-34

45-49

<160

120-129

<120

35-44

160-199

130-139

35-39

<35

200-239

140-159

120-129

240-279

160+

130-139

Yes

280+

140-159

Yes

40-44

160+

45-49

50-54

55-59

60-64

65-69

70-74

75+

Points

CVD risk

Heart age (years)

-3 or less

Below 1%

< 30

-2

1.1%

< 30

-1

1.4%

< 30

1.6%

1.9%

2.3%

2.8%

3.3%

3.9%

4.7%

5.6%

6.7%

7.9%

9.4%

11.2%

13.2%

15.6%

18.4%

21.6%

25.3%

29.4%

> 80

18 +

> 30%

> 80

Female risk estimate

Points

Age

HDL

Total Cholesterol

SBP Not Treated

SBP Treated

Smoker

Diabetic

<-3

<120

-2

60+

-1

50-59

<120

30-34

45-49

<160

120-129

35-44

160-199

130-139

35-39

<35

140-149

120-129

200-239

130-139

Yes

40-44

240-279

150-159

Yes

45-49

280+

160+

140-149

150-159

50-54

160+

55-59

60-64

65-69

70-74

75+

Points

CVD risk

Heart age (years)

-2 or less

<1%

<30

-1

1.0%

<30

1.2%

<30

1.5%

1.7%

2.0%

2.4%

2.8%

3.3%

3.9%

4.5%

5.3%

6.3%

7.3%

8.6%

10.0%

11.7%

13.7%

>80

15.9%

>80

18.5%

>80

21.5%

>80

24.8%

>80

28.5%

>80

21+

>30%

>80

More than 20 points

Significant risk of future cardiovascular disease requiring aggressive risk factor modification. You should see a health professional to ensure appropriate management.

If diabetic, your sugar levels should be well controlled.
Continue to avoid tobacco use or if you are a smoker, consider stopping this is something your General Practitioner can help you with.
Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.
Cholesterol levels should be assessed at least annually. Depending on your level, you might be advised to commence lifestyle changes or medication.

10 to 20 points

Elevated risk of future cardiovascular disease requiring risk factor modification. You should see a health professional to ensure appropriate management.

If diabetic, you should aim for your sugar levels to be well controlled.
Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.
Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.
Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.

Less than 10 points

Mild risk of future cardiovascular disease, consider risk factor modification. You may like to see a health professional to ensure appropriate management.

If diabetic, you should aim for your sugar levels to be well controlled.
Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.
Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.
Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.

This information will be collected for educational purposes, however it will remain anonymous.

Progression

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 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 high blood pressure
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

Page 1 2 3