How To Improve Heart Function After Congestive Heart Failure (CHF)

Heart failure costs the nation an estimated $30.7 billion each year. This includes the cost of health care services, medications to treat heart failure and missed days of work. And the prevalence of heart failure is projected to increase some 46% by 2030, when the American Heart Association (AHA) estimates more than 8 million people over 18 years of age will have heart failure. But more than anything, it costs individuals and families their ability to live healthy, normal lives. But increased understanding and treatment strategies for heart failure are giving hope to millions.

“If you have recently been diagnosed with a weak heart, there is hope,” said Dr. Mark Drazner, clinical chief of Cardiology, professor of Internal Medicine, and medical director of the LVAD and Cardiac Transplantation Program at UT Southwestern Medical Center. “With modern therapy, between 1/3 and 1/2 of patients can have significant improvement in their heart function.”

According to the “Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association (AHA)” published earlier this year in Circulation, about 6.2 million American adults had heart failure from 2013 to 2016, an increase from an estimated 5.7 million based on National Health and Nutrition Examination Survey (NHANES) 2009 to 2012.

The AHA reported that mortality associated with heart failure is substantial, such that it is mentioned in 1 in 8 deaths in America. And in 2016, heart failure was the underlying cause in 78,356 deaths including 35,424 males and 42,932 females.

According to the World Health Organization (WHO), cardiovascular disease (CVD) is the name for the group of disorders of heart and blood vessels which include:

• hypertension or high blood pressure;
• coronary heart disease – disease of the blood vessels supplying the heart muscle, or heart attack;
• cerebrovascular disease – disease of the blood vessels supplying the brain, or stroke;
• peripheral arterial disease – disease of blood vessels supplying the arms and legs;
• rheumatic heart disease – damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria;
• congenital heart disease – malformations of heart structure existing at birth;
• deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.

The AHA reports CVD currently claims more lives each year than cancer and chronic lung disease combined, and more than 360,000 people died in 2016 of coronary heart disease (CHD) or coronary atherosclerosis—the most common type of heart disease.

About half of people who develop heart failure die within 5 years of diagnosis, the AHA reports. But, declines in heart failure have been documented, reports the AHA, likely due to early treatment of heart failure risk factors and to implementation of the following:

• angiotensin-converting enzyme (ACE) inhibitors (heart medications that widen the blood vessels, increase the amount of blood the heart pumps, lowers blood pressure, and increase blood flow, which helps to lower the heart’s workload).
• β-blockers also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. Beta blockers cause your heart to beat more slowly and with less force, which lowers blood pressure.
• coronary revascularization or the restoration of blood flow to the heart.
• implantable cardioverter-defibrillators (ICDs), a pager-sized device placed in the chest to reduce death caused by the lower chambers of the heart (ventricles) going into dangerous rhythms and failing to beat effectively or cardiac arrest. Basically, ICDs detect and stop abnormal heartbeats or arrhythmias, continuously monitoring the heartbeat and delivering electrical pulses to restore normal heart rhythms when necessary. (An ICD differs from a pacemaker—another implantable device used to help control abnormal heart rhythms—as most new ICDs can act as both a pacemaker and a defibrillator.)
• cardiac resynchronization therapy (CRT) or biventricular pacing, involves implanting a half-dollar sized pacemaker to help improve the heart’s rhythm and the symptoms associated with the arrhythmia. Three wires or leads connected to the device monitor the heart rate and emit tiny pulses of electricity to correct any irregularities, in effect, “re-synchronizing” the heart.

Drazner, who has nearly 20 years of advanced training and experience treating patients with cardiomyopathy and advanced heart failure, offers 10 tips on how people who have suffered congestive heart failure can improve their heart function and live healthier lives (ie. if you have been told your heart is weak or your left ventricular ejection fraction (LVEF) is low):

1. Take beta-blockers which are proven to be beneficial for this reason, if you don’t have a contraindication. Beta blockers reduce your blood pressure. Also known as beta-adrenergic blocking agents, these medications work by blocking the effects of the hormone epinephrine, also known as adrenaline. According to Mayo Clinic, beta blockers cause your heart to beat more slowly and with less force, which lowers blood pressure. Beta blockers also help open your veins and arteries to improve blood flow. Some beta blockers mainly affect the heart. Others affect both the heart and blood vessels.
2. If you tried to take beta-blockers and were not able to do so, seek guidance of a heart failure disease management program. With education, sodium restriction and adjustment of your other medications, you may still be able to get onto beta blockers, and beta-blockers give you the best chance of having your heart function improve.
3. Follow a low sodium, low fat diet.
4. If you drink a lot of alcohol, stop (in this setting, complete sobriety could help your heart function).
5. If your thyroid is very overactive or underactive, fixing the thyroid problem could help your heart function.
6. If you use cocaine or speed, stop using those drugs.
7. If your doctor thinks you meet indications for a 3-lead pacemaker, that could help your heart function.
8. If your doctor says you have blockages in your coronary arteries and need those opened or bypassed, such procedures could help your heart function.
9. If you have never seen a cardiologist, consider making an appointment for a consultation. If you have seen a cardiologist and your condition remains poor, consider asking to be evaluated by a “heart failure cardiologist” for a second opinion.
10. If your heart was weak and the LVEF improved with the medications, do NOT stop those medications. Your heart can get weak again.