Heart failure is on the rise in younger people

The Heart Failure Society of America recently reported that heart failure is on the rise in the U.S. Even more disturbing is the news that it is rising faster in younger people ages 35 to 64 than in older people ages 65 to 84. Heart failure accounts for 45 percent of all deaths from cardiovascular disease.

There are several reasons for the increase, according to cardiologist Andrew Wall, MD, FACC, at the Cape Cod Healthcare Cardiovascular Center in Hyannis.

“Conditions like obesity, diabetes, coronary artery disease and high blood pressure are significant drivers of the associated mortality,” he said.

Other comorbidities include chronic kidney disease, sleep apnea, anemia, thyroid disorders, and heart rhythm abnormalities like atrial fibrillation.

The rise in heart failure deaths is especially significant in the Black, American Indian and Alaskan native populations, Dr. Wall said. Geographic variation also plays a role, with the highest heart failure death rates in the Midwest, Southwest and Southern states.

“I also think we as physicians are getting better at recognizing the condition with more diagnostic tools at our disposal both in the clinic and in the hospital, which has led to increased prevalence,” he said.

Diagnosing Heart Failure

To diagnose heart failure, Dr. Wall said cardiologists look for three main things:

• Shortness of breath with exertion that is out of proportion to normal exercise-induced shortness of breath.
• Being unable to lie flat due to shortness of breath. “People often say they have been sleeping in a recliner because it is more comfortable from a breathing standpoint,” he said.
• Waking up in the night extremely short of breath.

“Another thing to look out for is increased swelling, usually in the lower extremities, but this happens throughout the body from having too much fluid on board,” Dr. Wall said.

The two main types of heart failure are heart failure with “reduced ejection fraction” and heart failure with “preserved ejection fraction.” In heart failure with reduced rejection fraction, the heart’s main pumping chamber (the left ventricle) gets weak and can’t squeeze hard enough to pump out enough blood with each heartbeat.

Dr. Wall said the main causes of heart failure with reduced ejection fraction include:

• Heart attacks which damage the heart muscle
• Coronary artery disease which clogs the blood vessels that supply blood to the heart
• High blood pressure, which makes the heart work harder
• Dilated cardiomyopathies in which the heart muscle stretches, thins and becomes weaker, usually from things like heart rhythm problems, infections, alcohol, and other drugs.

In heart failure with preserved ejection fraction the heart pumps a normal amount of blood, but it is too stiff and has a hard time relaxing and filling up properly after each beat.

The main causes of heart failure with preserved ejection fraction include:

• High blood pressure which can make the heart thick and stiff
• Obesity, which puts strain on the heart and the body
• Diabetes, which can damage the heart and its blood vessels
• Aging, which naturally stiffens the heart over time
• Other conditions like kidney disease and sleep apnea

Treatment

The good news is that treatments for heart failure have gotten better and more effective.

“We are very fortunate to be living in such an exciting time for heart failure treatments, both for a heart failure with reduced ejection fraction and heart failure with preserved ejection fraction,” Dr. Wall said. “When treating heart failure with reduced ejection fraction we are focusing our treatments on helping the heart pump better.”

There are also medications that reduce the heart’s overall workload, lower blood pressure, help the body get rid of more sodium and water, and help lower blood glucose levels.

“The current combination of drugs for heart failure with reduced ejection fraction can lead to some amazing improvements in recovery of function,” he said. “Heart failure with preserved ejection fraction, on the other hand has proven a bit more difficult to treat.”

Most medications for heart failure with reduced ejection fraction have not shown the same benefits in people with preserved ejection fracture. But there have been some breakthroughs using new medications such as sodium glucose cotransporter 2 and diuretic therapies, he said. The new injectable weight loss drugs are also showing benefits.

Lifestyle Changes

People with either type of heart failure are advised to make healthier lifestyle changes. These changes can also help prevent heart failure from happening in the first place. They include all of the usual suspects:

• Keep blood pressure in check with medication, if necessary.
• Limit salt.
• Regular exercise.
• Eat a heart healthy diet and eliminate processed foods and foods that are fried or loaded with added sugar or salt.
• Maintain a healthy weight.
• Avoid smoking.
• Limit alcohol.
• Manage stress.
• Control diabetes.
• Get a good night’s sleep.

“Overall, eat healthy, move frequently and don’t smoke,” Dr. Wall advised.