Heart failure is one of those medical conditions that you’re guaranteed to hear during handover and is something most members of the public have heard of but often don’t understand. It effects 920,000 people in the UK and between 2015-16, Cornwall had 427 patients with heart failure admitted to hospital. This long-term health condition impacts on a lot of people and accounts for up to 2% of the NHS budget each year; heart failure has the capacity to impact on all other organ systems, with fluid backup affecting the kidneys, lungs, brain and systemic circulatory system.
So what is it?
Heart failure is defined as a “defect in heart function, either emptying or filling, leading to a rise in atrial pressures”. Heart failure is currently characterised based on whether the ejection fraction (EF) is reduced or preserved; EF is the percentage of blood the left ventricles pumps out with each contraction. Heart failure with reduced EF is caused by the ventricle losing its ability to contract and force blood out while preserved EF is due to the ventricle being unable to relax. Heart failure can effect both sides of the heart, typically starting on the left side; this can then impact on the right side of the heart due to backed up pressured through the lungs.
Who’s most at risk?
Heart failure is much more common in men up to the age of 85, at which point women take over. Those who have other long-term health conditions are much more likely to develop it, a third of patients also have diabetes, and 19% have COPD. There is a strong association between hypertension and heart failure as the constant high pressure in the ventricles, particularly the left, can lead the wall of the heart to thicken, impairing its ability to contract.
What causes it?
Myocardial infarction (heart attacks), ischaemic heart disease, left ventricular dysfunctions, hypertension and valve disease are the most common
How is it currently treated?
Diuretics (furosemide), beta-blockers (bisoprolol, atenolol), angiotensin-converting-enzyme inhibitor (lisinopril, ramipril), mineral corticoid receptor antagonists (spironolactone) – this is not an exclusive list.
Improving diet, exercising more, reducing alcohol and salt intake, all the usual stuff.
How does this impact people’s lives?
Heart failure can have a huge impact on a person’s life. Not only through the number of medications they may be required to take, but also the side effects of those medications. Diuretics are commonly used in heart failure to prevent the heart being overloaded with fluid, however this increases urination and urgency; some patients can find this difficult, especially when they’re out and about and don’t know where the nearest toilet is.
One of the more common symptoms associated with heart failure is increased fatigue, something that can have a significant impact on someone’s life, making even a trip to the shops difficult and exhausting. Patient’s can also dislike having to use equipment to help them get around, not wanting to look frail in public and the negative connotations that come with it. This decrease in mobility can have a big influence on a patient’s mood, making them more isolated and having to depend on others.
“person with heart failure, rather than the person with heart failure”
Over the course of a career in healthcare, you’ll meet dozens of patients suffering with heart failure. It is vital that you treat these patients, not just as their condition but also as everything that goes with it; whether this be their concerns over medication or the impact of the disease on their social life and mental wellbeing. Every patient will have a different history and different needs personal to them.
British Society for Heart Failure (2017) National Heart Failure Audit. Available at: http://data.gov.uk. (Accessed: 16 October 2018).
Cowie, M. R. (2017) ‘The heart failure epidemic: a UK perspective.’, Echo research and practice, 4(1), pp. R15–R20. doi: 10.1530/ERP-16-0043.
Leeming, A., Murray, S. A. and Kendall, M. (2014) ‘The impact of advanced heart failure on social, psychological and existential aspects and personhood’, European Journal of Cardiovascular Nursing, 13(2), pp. 162–167. doi: 10.1177/1474515114520771.