Failure is not an option

One-in-five people will develop heart failure (HF) in their lifetime. There are up to 90,000 people in Ireland living with HF and the estimated cost of the condition is €660 million per annum.

The Irish Heart Foundation has launched a new campaign, ‘Pay Attention to the Signs’, to raise awareness of HF symptoms. The campaign, supported by Novartis, aims to encourage those aged 50 and over to be aware of the signs of HF, as early detection of the symptoms can significantly improve a patient’s prognosis.

Swollen ankles, fatigue and shortness of breath are warning signs that should never be ignored in patients, according to the campaign.

Due to Ireland’s ageing population, the condition is set to increase dramatically, leading to a rise in HF hospitalisations of more than 50 per cent over the next 25 years.

Dr Angie Brown, Consultant Cardiologist and Medical Director, Irish Heart Foundation, said that HF can often go unnoticed because its symptoms come on gradually. “It’s easy to attribute tiredness to a busy lifestyle, and breathlessness to being out of shape. These are signs we need to watch out for.”

One-in-five people over 65 years presenting to their GP with breathlessness will have unrecognised HF, Dr Brown told the Medical Independent (MI). Furthermore, the incidence is expected to increase substantially over the next 30 years, but despite this, Ireland’s public awareness of the signs, symptoms and causes of HF is very low, she noted.

“This is why our campaign is aimed at the general public. In addition to the discussions on the radio, our campaign materials include posters, leaflets and a brochure; there is also information on our website or via the nurses helpline, 1800 25 25 50. Any GP can get in touch and receive the materials or download from our website [www.knowyourheart.ie].”

<h3>General practice</h3>

Dr Brown said it is important that GPs remain aware of how common HF is. She said that while GPs are well aware of HF symptoms, it can often be difficult to diagnose.

“Some of the main symptoms are breathlessness and fatigue, which are quite non-specific and can be due to other things, such as a chest infection or underlying lung disease, or even in some people due to deconditioning. It is therefore important to have a high index of suspicion, particularly in patients with risk factors such as ischaemic heart disease, hypertension, valve disease or diabetes. If heart failure needs to be excluded, a blood test to measure the natriuretic peptides (BNP) is very useful, as it is elevated in heart failure. Patients can then be referred for an ECG, ECHO and specialist review.”

Dr Angie Brown

Once a diagnosis of HF has been made, the patient will be started on several types of medication (ACE inhibitors, beta-blockers, angiotensin receptor blockers (ARBs), hydralazine with nitrate, diuretics, aldosterone antagonists, sacubitril/valsartan, ivabradine and digoxin, etc) to improve the heart function, control blood pressure and heart rate, and remove any fluid from the lungs. These medications can improve symptoms as well as heart function and lower mortality. “Other treatment may be necessary, depending on the cause of heart failure — for instance, if it is due to a narrowed heart valve, this may need replacing, or if it is due to blocked heart arteries (ischaemic heart disease) then the patient may need a stent or a heart bypass. Some people may need a special sort of pacemaker. All of the treatment available now means that people’s symptoms and prognosis if they have heart failure has improved compared to years ago, when these weren’t available,” Dr Brown said.

<h3>Gender</h3>

Women often have different cardiac symptoms to men and can underplay their symptoms, Dr Brown noted. “Women are protected in part by their hormones but after the menopause, the risk of developing heart disease increases and catches up with men, so it is equally important for women to be investigated for heart failure if they present with fatigue, dyspnoea, swelling of the ankle [and] some may complain of ‘gasping’ or inability to lie flat in bed or wake up at night breathless. Some may have palpitations or dizzy spells.”

In summary, Dr Brown said it is important for everyone to be aware of their HF risk factors, “so to get blood pressure, cholesterol and blood sugar checked, try and keep to a healthy weight, eat a healthy diet, cut down on alcohol, stop smoking and if a person has breathlessness, fatigue or swollen ankles, that they get a check-up with their GP”.

<h3>Patient information meetings</h3>

The Irish Heart Foundation will hold two public information meetings on HF in the coming weeks. The meetings are suitable for people with HF and their families, healthcare staff and anyone with an interest in HF.

Waterford

The evening will feature talks by leading medical experts from University Hospital Waterford, including Consultant Cardiologist Dr Pat O’Callaghan, to increase awareness and understanding of the condition. The Foundation will launch a HF support group at this meeting.

Date: Thursday, 19 April.

Time: 6.30pm-9pm.

Location: Woodlands Hotel, Dunmore Road, Waterford.

Dublin

The evening will feature talks by leading medical experts from the Mater Hospital, Dublin, including Consultant Cardiologist Prof Niall Mahon, to increase awareness and understanding of the condition.

Date: Thursday, 12 April

Time: 6.30-9pm

Location: Ashling Hotel, Parkgate Street

<h3>Resources</h3>

The Irish Heart Foundation also runs a National Heart and Stroke Helpline staffed by specialist nurses. Freephone 1800 25 25 50, Monday to Friday, 9am-5pm. A range of patient support and information booklets are available at https://irishheart.ie/publications/.