Heart failure: The misunderstood cardiovascular disease

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CHFS_logo_300It is a tribute to the extensive education efforts of the past 20 years that the general public has a good understanding about many things to do with cardiovascular disease: heart attack, arteriosclerosis, cholesterol, high blood pressure, cardiopulmonary resuscitation, and even defibrillation (thanks to all those hospital TV dramas).

There is, however, one glaring exception in this good level of public cardiovascular knowledge, and it’s a big one: heart failure.

Though hard data are difficult to come by, it is clear there is an important gap in public knowledge about what heart failure is, its consequences and what could be done to help prevent it.

This knowledge gap is important because heart failure is a serious condition. With our aging population, there will be an even greater epidemic of heart failure in the coming years, with important consequences not only for those affected and their families but for our health system.

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Perhaps the problem starts with the name, “heart failure.” This gives rise to too much confusion with heart attack – a sudden-onset event from which most people recover. Heart failure on the other hand, is a chronic condition which can begin suddenly, but more often occurs gradually. It is an inability of the heart to pump sufficient blood to meet the body’s needs and can exist at many different levels, and left unchecked, usually progresses over time from mild to severe, with ultimately fatal consequences. From a public education point of view, it would be better if heart failure were called “progressive heart weakness” or “heart disability,” terms which would not imply that it is “game over” or that those who suffer from it have “failed”. The French term for the condition, “insuffisance cardiaque” – “cardiac insufficiency” – is much more precise.

It is more remarkable that heart failure is so little understood given the huge toll it takes on Canadians. One in five Canadians will develop heart failure (men and women equally) in their lifetime and more than 600,000 have heart failure right now. It is responsible for about nine per cent of all deaths in Canada or about 22,000 per year, which is more than the deaths from breast, colon and prostate cancer combined.

Heart failure is not an easy disease. As people develop more symptoms – both physical and cognitive impairment – they can do fewer and fewer activities and require more care, placing a huge burden on spouses and family members, often to the detriment of the caregivers’ health.

Heart failure reduces patient quality of life by causing shortness of breath, fatigue, swelling of legs and cognitive impairment, among other symptoms. These symptoms can flare at different times as the condition progresses, requiring hospitalization. As a result, heart failure is the second leading cause of hospitalization in patients over 65 years of age. These patients generally stay longer in hospital than others and the 30-day hospital readmission rate for Canadian heart failure patients is 21 per cent, creating an additional burden.

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Treatments for heart failure have greatly improved over the years, with reductions in death and hospitalization of up to 80 per cent in some cases. However, as the above statistics show, there is certainly much room for improvement – for the benefit of patients, caregivers and the health system. It is exciting to see that new therapies are being developed that have shown in phase 3 clinical studies to have actual benefit on mortality and hospitalization rates. We are certainly not yet at the stage of being able to stop or reverse heart failure, but there are promising new treatments anticipated to be available in the near future that could delay activity-limiting symptoms and the need for some hospitalizations provide great overall benefit.

We also need to correct the knowledge gap about heart failure, which is one of the missions of the Canadian Heart Failure Society. As we have seen with other conditions in the past, knowledge is a key partner with treatment in lessening the burden of illness.