Reviewed By Michael Smith
The name "heart failure" couldn't sound bleaker, and anyone who lives with it knows it is a frightening and serious medical condition. The physical symptoms of heart failure, combined with the depression and anxiety that it can sometimes provoke, may make you feel weak and vulnerable, as if you've lost control of your life.
But as debilitating as heart failure can be, there is still a great deal that you can do to improve your condition. And specialists stress that management provides so much hope for your future.
"Taking control can make people with heart failure feel better," says Susan J. Bennett, DNS, RN, a professor at the Indiana University nursing school who has extensively studied the quality of life in patients with heart failure. "It feels good to be doing something positive, and there's evidence to suggest that it really can help your emotional state."
Taking control of your treatment will help more than your state of mind. By being on top of your condition -- learning about heart failure, following your doctor's recommendations, taking your medications, eating well and even exercising -- you may also greatly improve your prognosis.
Good nutrition is an important aspect of controlling heart failure. Obesity is a major contributor to the condition, and eating a diet low in fat and high in fruits and vegetables is important. In general, you also should limit the amount of alcohol and caffeine that you take in.
Experts also agree that people with heart failure should follow a low-sodium diet. But how low? Bennett observes there are problems with eating a diet too low in sodium and there are other factors to consider.
"One thing that's clear from my work is that food just doesn't taste as good when you're eating a low-sodium diet," Bennett tells WebMD. Because of this, it's a diet that's not only difficult to stick to, but also one that may contribute to nutritional problems.
"The low-sodium diet sometimes causes people to reduce their caloric and nutritional intake," says Bennett. "When you start trying to follow a 2-gram sodium diet, there are a lot of foods that you may not be able to eat. Also, foods high in protein also may be high in sodium, so when you reduce salt, you also reduce protein."
A deficiency in protein can lead to unhealthy weight loss and muscle wasting, which are serious -- and often underestimated -- symptoms of heart failure. For example, in one study testing implanted left ventricular assist devices -- machines that increase the pumping power of the heart -- one of the most common and somewhat unexpected complications after surgery was the result of preexisting nutritional problems.
"Heart-failure patients seem to be nutritionally out of balance," says John Watson, MD, director of the clinical and molecular medicine program in the National Heart, Lung and Blood Institute's Division of Heart and Vascular Diseases. Watson believes nutrition is an important issue to address, especially for those about to undergo major surgery.
"I think that we need to be looking at a bigger picture of adequate nutrition and there's still a lot we don't know," says Bennett. For now, she recommends a diet that restricts sodium but also follows basic nutritional advice. You should talk with your doctor, nurse, or dietitian about what sort of diet and sodium restrictions make sense in your case.
Given the weakness that many people with heart failure experience, which can even make moving across a room exhausting, the idea of exercise may seem ludicrous. "We used to tell people with heart failure to just rest," says Bennett, "but now we know that in many conditions, you're probably healthier if you get a little exercise."
Indeed, a recent statement from the American Heart Association, based on a review of the medical literature, indicated that exercise seems to be beneficial for heart failure patients, even for those with advanced forms of the disease.
Of course, anyone with heart failure absolutely must check with a doctor before undertaking an exercise plan. But all sorts of aerobic activity -- walking, biking, and swimming, for instance -- appear to be beneficial in many cases. Exercise improves the condition of blood vessels and lowers the levels of harmful hormones in the bloodstream.
Exercise also makes people feel better, it improves heart-failure symptoms, and it makes it easier to do normal, everyday physical tasks that can become difficult in advanced stages of heart failure. The American Heart Association recommends 20 to 30 minutes of aerobic activity three to five days a week; people with advanced heart failure may need longer warm-up periods.
However, Bennett cautions we still need more data from large studies before we can be sure of the types and amounts of exercise to recommend for heart failure. She also points out the benefits of exercise have been shown only in patients who were medically stable, so it may not be safe for everyone.
"I think that exercise may play an important role in treatment," says Bertram Pitt, MD, internal medicine professor at the University of Michigan. Although he cautions that we don't know all of the answers yet, he is optimistic about a new study of exercise in heart failure patients that has just begun.
Getting a good night's sleep is, not surprisingly, good for people with heart failure -- just as it is for anybody. But for people who sleep less than eight hours a night, a recent study suggested that the less you sleep, the higher your risk of developing heart disease. The reasons aren't entirely clear, but it is known that during sleep, the pulse, blood pressure, and levels of certain hormones are lowered, allowing the body to rest.
Unfortunately, some medications used to treat heart failure may make it hard to sleep soundly. For instance, people taking diuretics often wake up several times a night to go to the bathroom; talk to your doctor about scheduling your doses to help lessen or prevent this problem.
A particular concern for people with heart failure is a connection between this heart problem and sleep apnea, a disorder in which a person temporarily stops breathing for ten seconds or more while asleep. Sleep apnea -- usually caused by a physical obstruction in the airway -- is seen in about a third of people with heart failure. Treatment involves surgery or wearing a breathing mask during the night. A recent study showed that treatment with the breathing mask -- called CPAP -- improved symptoms of both heart failure and sleep apnea.
Staying in Control
There are a number of other ways that people with heart failure can take control of their disease. The most important is to see your doctor regularly and to establish an effective partnership with medical professionals. Good management of your condition improves your prognosis, reduces the chances of being hospitalized, and improves your quality of life, according to Bennett.
Sticking with your drug treatment is also crucial. No matter how beneficial a drug has been proven to be in clinical studies, it's not going to help you unless you take it. This isn't true only for your heart-failure medications. Other conditions -- like high blood pressure or diabetes -- can also make heart failure worsen if they are not controlled, so make sure you're taking all of your medications faithfully. If side effects are making it difficult to take your prescriptions, talk to your doctor.
On your own, you should be weighing yourself daily and checking for signs of swelling called edema -- a sudden weight gain could be a sign of fluid retention. And if you still smoke, you need to quit. You should also limit the amount of exposure that you get even to second-hand smoke.
Reducing stress and anxiety is important, although your condition can certainly provoke such feelings. Depression is a risk for people with heart failure. "A lot of people with heart failure become depressed," says Bennett, "anywhere from 20%-60%." She also notes that, in some groups, depression can worsen the prognosis. However, she thinks doctors generally are aware of the problem and looking out for it.
Bennett also stresses that health professionals need to make certain that older people with heart disease get the support they need at home. "People tend to isolate themselves when they're sick, and we need to be looking at family and support systems for people with heart failure," says Bennett. "We need to see whether older people are able to carry groceries in the house, or whether they can prepare fresh fruits and vegetables or open cans and jars. These things make a difference."
Preventing Worsening of Heart Failure
Lifestyle changes can even help prevent or slow the progression of heart failure.
The healthcare system should be doing much more to prevent people from reaching the late stages of the disease, according to Jay N. Cohn, MD, a professor in the cardiovascular division of the department of medicine at the University of Minnesota Medical School.
"I think that the rise in heart failure can be slowed significantly by early detection and aggressive medical treatment," Cohn tells WebMD. "But the problem is that these patients don't get into the hands of specialists until they become sick, and by then it's too late for aggressive preventative intervention. People who have late-stage heart failure represent a failure of our medical system."
He suggests that those who are concerned about worsening heart failure should talk to their doctors and, if possible, try to get a complete workup at a center that specializes in treating heart conditions.
"Although specialty centers are still rare, I believe that this is the potential future of cardiovascular care in our country," says Cohn. "We have to detect it early and treat it aggressively."
For now, Bennett believes that doctors need to make sure they give patients concrete advice about diet and other lifestyle changes they need to make. "It's not enough to say, 'Take it easy,' or, 'Watch your salt,' or, 'Try to walk more,'" she says. "People need more specific information."
While heart failure remains a very serious and dangerous disease, people diagnosed with it have good reason for hope.
"The one message that I think is worth getting across is that the current management of heart failure is far better than people think," says Cohn. "Every paper on the management of heart failure starts out with an obligatory statement about how terrible a disease it is and how bad the prognosis is. But that's really wrong. The prognosis is now quite good and so much better than it once was."
Originally published May 2003.
Medically updated October 2004.
SOURCES: Susan J. Bennett, DNS, RN, Professor in the School of Nursing, Indiana University, Indianapolis; affiliated scientist, Indiana University Center for Aging Research. Michael R. Bristow, MD, PhD, University of Colorado Health Sciences Center, Denver, Colorado; co-chair of the COMPANION study. Jay N. Cohn, MD, Professor, Cardiovascular Division in the Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; past president of the Heart Failure Society of America. Marvin A. Konstam, MD, Chief of Cardiology, New England Medical Center; Director of Cardiovascular Development, Tufts-New England Medical Center; President of the Heart Failure Society of America. Bertram Pitt, MD, Professor of Internal Medicine, University of Michigan; Principal Investigator for EPHESUS and RALES trials. Eric A. Rose, MD, Chairman of the Department of Surgery, Columbia University College of Physicians and Surgeons; Surgeon-in-Chief, Columbia Presbyterian Medical Center, New York-Presbyterian Hospital; principal investigator for REMATCH trial * John Watson, MD, Director of the Clinical and Molecular Medicine Program in the National Heart, Lung and Blood Institute's Division of Heart and Vascular Diseases; project officer for the REMATCH trial.
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