Heart failure prevention

Abstract

Heart failure takes a tremendous toll on patients and the health-care system. According to the National Heart, Lung, and Blood Institute (NHLBI), 5.7 million adult Americans had heart failure in 2012, and that number is expected to rise by 46 % by 2030. Despite significant advancements in therapies with improved morbidity, the 1-year mortality rate is 29.6 %, and cumulative mortality is almost 50 % within the first 5 years after initial diagnosis. More than 1.8 million office visits and 676,000 emergency room visits were attributed to heart failure in 2010. In 2012, the direct medical costs of heart failure exceeded $21 billion, with a projected increase of almost 127 % by 2030. The good news is the impact of prevention on the reduction of heart failure. As one example, 75 % of heart failure cases had predisposing hypertension; the lifetime risk for people with a blood pressure (BP) > 160/90 mmHg is double that of those with a BP < 140/90 mmHg. The Coronary Artery Risk Development in Young Adults (CARDIA) study identified hypertension, obesity, and systolic dysfunction as important risk factors amenable to prevention. Thus, the "heart failure tide" is turning to a bigger focus on prevention, rather than a singular focus on treatment. As with other diseases, early detection is vital as is eliminating or reducing risk factors and treating them aggressively. Common, preventable risk factors include hypertension, dyslipidemia, obesity, and diabetes mellitus. This chapter also describes other areas where prevention can make a big difference, such as with heart failure's association with social behaviors ranging from alcohol abuse to use of cocaine, androgenic steroids, and amphetamines (recreational use)-and heart failure's relationship to the human immunodeficiency virus and chemotherapy. Eliminating or reducing risk factors and treating them adequately will not only reduce morbidity and mortality but can maintain patients' quality of life and reduce health-care costs.